Contra Costa Behavioral Health System Transformation …



April 2015Dear Contra Costa County Community:I am excited to share with you the progress we have been making in our efforts to transform our County’s behavioral health system. As you may recall, three years ago, when I was appointed Director for the new Contra Costa Behavioral Health Division (BHD), I was charged with overseeing the transformation of our separate Mental Health, Alcohol and Other Drug Programs, and Homeless services into a welcoming, recovery-/resiliency-oriented, and integrated system of care, one that would be better able to meet the needs of our clients, both individuals and families, who have complex, co-occurring conditions. We embarked on this journey knowing that such an integration effort would be a complicated endeavor, however, we were motivated by a desire to improve quality of care and outcomes for our clients and to enhance the overall efficiency of our operations. Significant research across the country has documented the effectiveness of integrating services for populations with co-occurring conditions and multiple needs, and here in Contra Costa County we have had numerous successful examples of integrated programming. The decision to merge our Mental Health, Homeless, and Alcohol and Other Drug programs and services was a decision to take our many project-specific successes to a system level, thereby applying universally the lessons we have learned about the long-term effectiveness of integrated, person/family-centered, strength-based, culturally-informed and trauma-informed service delivery. As we move towards the mid-point of our transformation effort, I want to report on what we have achieved over the past three years, and point to what is left to be done. As we began our change process, we set out four overarching goals which have directed our efforts. In the chart/graphic below you can see an overview of our progress, measured by the initial goals we set. As you can see, we are fully on track. As you can imagine, this transformation effort has been both inspiring and difficult. Work is underway on multiple levels simultaneously, creating a structure and process within which we can address system level policy, program design and standards, clinical practice development, and workforce training and competency. Not surprisingly, we have also had to confront a range of obstacles and fears – change is never easy, and the changes required to merge multiple systems of care into one integrated division are monumental. But through leadership and committed perseverance at all levels, we are moving forward and accomplishing our goals. The Behavioral Health Division, its operations and staff, are all stronger for this effort. In the subsequent pages of this report, I proudly share with you our accomplishments to date, and applaud you and thank you for participating. For sake of clarity, we have organized the report by the three Phases of our Behavioral Health System Transformation process. Each Phase is described along with its key activities and accomplishments. Thank you for taking the time to read this report, and for joining us on this journey. With the resolve, vision and creativity of all of our partners—consumers/family advocates, MH, AOD and Homeless commissioners and advisory board members, executive leadership, CBO leadership, other Health Services department divisions, and County program managers and line staff—we are moving steadily toward our goal of an integrated, customer-oriented system of care that is complexity capable, trauma-informed, culturally-informed, and recovery-/resiliency-oriented. Sincerely, Cynthia Belon, LCSWDirectorContra Costa County Behavioral Health DivisionContra Costa Behavioral Health System Transformation Flowchartcenterbottom00Contra Costa Behavioral Health System Transformation OverviewOur transformation process is being carried out in three phases. We are at the mid-point of the process now, with the next three years being devoted to implementation based on the collaborative and in-depth planning and design work that has occurred. The flow chart on the preceding page provides a schematic overview of our process, and the subsequent pages of this report provide a more detailed accounting of our progress, activities and accomplishments. Phase 1: Planning & Research (2012-2013)Effectively integrating three formerly separate systems of care into one Behavioral Health Division (BHD) is a complicated process in which planning and design work must be carried out on numerous simultaneous dimensions. In order to accomplish this task, we needed to develop a shared vision to guide our efforts and integrated structures within which we could collaboratively design our new Division. We also needed to engage our partners throughout the County to participate in this shared process of transformation and to begin development of the leadership, relationships, coordination and communication needed for the future Phases. Our efforts were directed simultaneously on developing an internal infrastructure and partnership within County operated systems, and on developing a wider partnership with all our stakeholders—consumers, families, CBO providers, and other Health Services department divisions—across all mental health, alcohol and other drug, and homeless prevention, early intervention, and treatment services.As such, during this first Phase, we established the transitional infrastructure we would need to launch the transformation and we initiated the learning and relationship development essential to true collaboration and partnership. We formed a variety of integrated groupings and conducted simultaneous discussions that involved County leadership and staff, CBO partners, and consumers and family members to help identify how the systems and its programs currently function, and then to identify and assess opportunities for change and improvement. These early discussions provided an essential base for the transformation process, allowing us look at our own operations and assess their “recovery-/resiliency-oriented complexity capability”, understand the operations of other systems and agencies, develop a shared vision, understanding and vocabulary, and to forge relationships and trust. While in the next section we lay out the concrete activities and accomplishments of this Phase, it is important to note that one of the most important accomplishments was towards the development of trust and understanding among the partners. This provides the essential basis for the collaboration required in the design and implementation phases, as well as the partnership that is needed continue the work of providing flexible, consumer-oriented services in a fully integrated system. Phase 1 Activities and Accomplishments Development Of A Mission And Vision to guide our transformation process and the new integrated Behavioral Health Division: These were developed through a collaborative stakeholder process, including County leadership and staff, and were approved on August 20, 2012. Our mission and vision helps us ensure that all of our activities, across all of our planning structures, are jointly aligned. A Bimonthly BHD Newsletter was initiated in May 2012 to facilitate communication by providing updated information on the integration process.Establishment Of Temporary Teams for Integration Transformation that were used for planning, oversight and implementation: These group structures ensured that our first phase of work was rooted in a collaborative process, informed by MH, AOD and Homeless programs, by leadership and line staff, by CBO partners, and by consumers and their families. Importantly, they launched the development of relationships and increased understanding across systems and programs. Each team met during Phase 1 and provided essential feedback. Some of these groups continued in Phase 2 and 3, others were active only for a brief span of time. The following is an overview of the key groups for our team-based approach during our initial transformation. Phase 1 Activities and Accomplishments Phase 1 Activities and Accomplishments Phase 2: Program Design (2013-2015)During Phase 2, we continued and deepened the discussion, planning and analysis initiated in Phase 1. Primarily through the new SPIIDS Team structure, we identified key practices for integrated care and developed common frameworks for how they should be implemented across the four lifecycle populations. These frameworks addressed integration in both administrative and clinical redesign, including: Programs, services and service delivery: welcoming, hope, and access, delivery of integrated care in any door, and collaborative partnership across the systemClinical policies/procedures/tools: access, screening, assessment, recovery planningQuality Improvement, Utilization Management, Data, and Performance MonitoringWorkforce development in partnership with front line staffFinancing (budgeting, billing, contracting) so that every dollar supports integrationBased on the common frameworks, action happened on two levels: 1) each agency and program evaluated their own operations and made whatever accessible change they could in the direction of improving Complexity Capability, based on current structure and operations and 2) larger full system integration change was designed and planned for, anchored in a continuous quality improvement partnership process. Both levels of action concurrently focus on continuously improving programs, services, policies and practices in accordance with the BHD Transformation Vision and Mission, the principles of the “Comprehensive Continuous Integrated System of Care” (CCISC) and the frameworks developed for each lifecycle population; developing workforce competency among all staff; and establishing quality improvement partnerships to monitor that programmatic changes are meeting system goals. Phase 2 Activities and Accomplishments The SPID Teams Were Expanded in 2013 to become hybrid all-sector mini-groups called SPIID (Services & Programs Integration Implementation Design) Teams, encompassing consumers and family members, County program managers and line staff, community-based organizations (CBOs), and change agents. These Teams expanded on the System of Care Design Research Resource Notebooks, compiling program profiles, sharing knowledge through case studies, identifying successful examples of integration already underway in the County, and vetting topics and strategies. The Identification of Integration Opportunities by the BHD Executive Team together with SPIID Team leaders to infuse integrated practices into the infrastructure and overall operations of the Division. Discussions and actions focused on:Designating staff to participate on internal teams, to reach out to CBOs to attend key meetings, and to infuse the Division with integration activity as the norm. For example, AODS and Homeless programs staff will participate in Children’s Policy and Planning Meetings, attend the Contractor Luncheon, and work with other County Departments.Exploration of development of trainings on shared practices and tools.Identification of funding opportunities, reasonable shifting of resources and tasking of positions to accomplish the recommendations, through normal budgetary channels and emerging opportunities.Development of an Organizational Structure for the Behavioral Health Division by the Executive Team that will facilitate integrated treatment, services and programs. Restructuring to take place in 2015.Development of Common Frameworks for Integration: The SPIIDS Teams developed four common frameworks for an integrated system of care. These frameworks function as design tools to facilitate movement towards implementation of an integration best practice. They identify what is currently in place and what is needed, and they suggest how to begin implementation. Frameworks have been developed around the following topics: Integrated Case ConferencingIntegrated HubsIntegrated Service TeamsIntegrated Treatment of Co-Occurring Disorders.Development Of Next Steps Program Design Proposals: The SPIIDS Teams developed program design proposals, which were approved by the Executive Team for 2015 implementation. These proposals lay out specific steps for initiating implementation of the integration frameworks for each of the four lifecycle populations. Phase 2 Examples of Integration Work Underway Throughout Phase 2, we have been asking ourselves the questions: What do we have? What can we build on? What do we need? This section describes some examples of integration work underway in Contra Costa County that exemplify our Mission and Vision.West County Health Center (El Portal) The El Portal Clinic provides mental health services to Medi-Cal and low income Central or South Contra Costa adults including: assessment and evaluation, medication support services, medication evaluation and management. The clinic also has specialized services for the TAY population. The El Portal Clinic has been an integrated hub since January, 2014, and staffing now includes and AOD specialist and Housing Specialist in addition to Mental Health staff. Behavioral Health Access LineThe Mental Health Access Line is transitioning to the Behavioral Health Access Line. This transition includes the integration of AOD and Homeless Programs into the Access line services as well as improvements to the infrastructure of the system, such as decreasing wait times to speak to clinician, reducing number of unnecessary calls, improving accuracy of connections to clerks versus clinicians who can handle more challenging cases, and adding a call back feature. Concord Health Center (Respite Center)The Philip Dorn Respite Center, located in Concord, is a respite care program for homeless adults who are discharging from local hospitals and require medical stabilization services. Respite care refers to recuperative services for those homeless persons who may not meet medical criteria for hospitalization, but who are too sick or medically vulnerable to reside in an emergency shelter and cannot be returned to the streets. This program is a joint effort between the Homeless Program and?Health Care for the Homeless. The primary goal of this program and all emergency housing programs is to get homeless persons off of the street and help them achieve their highest level of self-sufficiency.Services Include:Case management (resources, advocacy, and guidance)Medical care and linkagesEnrollment in Benefits and health coverageReferral for alcohol/other drugs detox and residential treatment servicesMealsHousing Search assistance Phase 2 Examples of Integration Work Underway Integrated Service Teams Doing Integrated Case ConferencingChildren’s Mental Health – WraparoundLincoln Child Center – MDFT Mental Health TAY Crossover MeetingsOutreach teams, including Central County Outreach, Project HOPEMobile Response TeamsHealth Care for the HomelessAnka MSCs and Case RoundsForensics TeamDiscovery Housing Case RoundsHomeless Program Case Rounds – Concord Shelter, Respite CenterHomeless Case Conferencing with entire family and all relevant children’s providersOlder Adult WRAPExamples of Integrated Service TeamsHOPE Team (Lincoln Child Center)Health Care for the HomelessAnka ISTsBridges to Home / Rubicon Programs ACT team Forensics TeamMH Transition TeamYoung adult team in East County (Nierika House to transitional housing)Respite CenterExamples of Integrated HubsConcord Health Center and Building 2 expansionEl PortalRYSE Center RichmondClub House in Central County (client driven program)Calli House Anka MSCsGRIPClubhouse in Central CountyGale Uilkema HouseAdditional Examples of Integration Integrated Assessment: 211 Database; Access Line; Expanded access to Epic system; Children’s Mental Health CANS implementation; Homeless programs working on coordinated assessment; Concord and Brookside SheltersLiaisons: McKinney-Vento education liaisonPeer Supports: Alumni Associations; Homies for the Homeless; Office for Consumer EmpowermentFor ongoing updates about additional examples of integration, please contact the County Behavioral Health Division. Phase 3: Implementation & Continuous Quality Improvement (2014 - Ongoing)The Phase 3 focus is on ongoing implementation of the SPIID Team common frameworks for integrated case conferencing, integrated hubs, integrated service teams, and integrated treatment of co-occurring disorders. To initiate this work, the Executive Team will oversee implementation of the program design proposals next steps for each lifecycle population, and will work to strengthen staff capacity to implement through use of existing reporting structure, resources and positions; explore development of trainings on shared practices and tools; and be alert to every funding opportunity, reasonable shifting of resources or tasking of positions to accomplish the recommendations, through normal budgetary channels and emerging opportunities. In addition, the County Integration Roundtable will explore the internal implementation these strategies across the Division. Our Phase 3 system transformation work is an ongoing process of implementation to achieve long-term system change. This work will be supported and monitored through Continuous Quality Improvement (CQI) partnerships. Each agency or program will create Continuous Quality Improvement Teams, composed of an empowered partnership between leadership, front line staff and consumers that will organize the improvement process within that agency or program, recommend and implement improvements, measure progress, and celebrate success. This collective effort will fuel continuing progress that will be monitored and measured at each of the following levels: System policy direction (including funding, administrative, and clinical policies)Co-occurring/complexity-capable program design and standardsRecovery-/resiliency-oriented, strength-based, integrated clinical practice developmentRecovery-/resiliency-oriented, co-occurring/complexity-competent workforce development.Phase 3: 2015 Action FocusImplementation Of The New BHD Organizational Structure, developed by the Executive Team. Next Steps In Implementing Common Frameworks For Integration: The Executive Team, in conjunction with the County Integration Roundtable, will facilitate the following implementation actions for each lifecycle population (see next two pages). Behavioral Health Access Unit: The Executive Team will complete the project of integrating the Access Line, allowing callers in need of multiple behavioral health services to get all the help they need by dialing one number.ConclusionWe are well on the way to an integrated and transformed Behavioral Health Division that includes: A new Behavioral Health Division culture (shared values, beliefs, norms)Policies, practices and structures that sustainably support the new system Integrated, complexity-capable programs and services Complexity competent staff.All of these together will allow us to achieve our core goal of integrated, customer-oriented system of care that is complexity capable, trauma-informed, culturally-informed, and recovery-/resiliency-oriented. This will means better care and outcomes for our clients, and it will mean more efficient use of resources for our County. center177165To subscribe to Behavioral Health Connection, the newsletter of the Behavioral Health Division, please visit subscribe to Behavioral Health Connection, the newsletter of the Behavioral Health Division, please visit or comments about the Contra Costa Behavioral Health System Transformation may be directed to BHCommunications@county.us. ................
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