MHSA INNOVATIONS

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MHSA INNOVATIONS

• AN OVERVIEW OF PURPOSE, REQUIREMENTS
• AND DEVELOPMENT OF INNOVATION WORK PLANS
• COUNTY OF LOS ANGELES
• DEPARTMENT OF MENTAL HEALTH2009

DKH-JUNE 16, 2009
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MHSA INNOVATIONS (INN) COUNTY OF LOS
ANGELES-DEPARTMENT OF MENTAL HEALTHAN OVERVIEW
OF PURPOSE, REQUIREMENTS AND DEVELOPMENT OF
INNOVATION WORK PLANS

• What is the Mental Health Services Act?
• How does the Innovations Plan fit in?
• How much funding is there?
• 40 million over two years

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MHSA INNOVATIONS (INN) COUNTY OF LOS
ANGELES-DEPARTMENT OF MENTAL HEALTHAN OVERVIEW
OF PURPOSE, REQUIREMENTS AND DEVELOPMENT OF
INNOVATION WORK PLANS

• PURPOSE OF INNOVATIONS WORK PLAN FUNDING
• To encourage novel, creative and/or ingenious
  mental health practices and approaches that
  contribute to learning
• To develop mental health practices and approaches
  through a community informed process that are
  representative of the communities to be served,
  especially unserved, underserved and
  inappropriately served communities
• To develop new mental health practices and
  approaches that can be replicated and adapted to
  other populations and other counties if proven to
  successfully serve a specific population

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MHSA INNOVATIONS (INN) COUNTY OF LOS
ANGELES-DEPARTMENT OF MENTAL HEALTHAN OVERVIEW
OF PURPOSE, REQUIREMENTS AND DEVELOPMENT OF
INNOVATION WORK PLANS

• STATE GUIDING PRINCIPLES FOR DEVELOPING
  INNOVATIONS PLANS
• Learning Focused
• Must focus on presenting a new practice for the
  primary goal of learning and increasing the array
  of creative and effective approaches that can be
  applied to mental health services for specific
  populations
• Consistent with 6 MHSA Principles
• Community Collaboration
• Cultural Competency
• Client-driven mental health system
• Family-driven mental health system
• Wellness, Recovery and Resiliency Focus
• Integrated Service Experience

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MHSA INNOVATIONS (INN) COUNTY OF LOS
ANGELES-DEPARTMENT OF MENTAL HEALTHAN OVERVIEW
OF PURPOSE, REQUIREMENTS AND DEVELOPMENT OF
INNOVATION WORK PLANS

• Essential purposes of Innovations
• Promote interagency collaboration
• Increase access to services
• Increase the quality of services, including
  better outcomes
• Increase access to underserved groups
• Scope of Innovation Innovations may
• Address the unmet needs of the existing age-group
  populations or influence individuals across age
  groups
• Address unmet needs of defined neighborhoods,
  tribal and other communities, counties, multiple
  counties, or regions.
• Initiate, support and expand collaboration and
  linkages, especially connections between systems,
  organizations, healers, and other practitioners
  not traditionally defined as a part of mental
  health.

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MHSA INNOVATIONS (INN) COUNTY OF LOS
ANGELES-DEPARTMENT OF MENTAL HEALTHAN OVERVIEW
OF PURPOSE, REQUIREMENTS AND DEVELOPMENT OF
INNOVATION WORK PLANS

• Los Angeles County Priorities
• Uninsured Population
• Under Represented Ethnic Populations (UREP)
• Homeless Population
• Integration of health, mental health and
  substance abuse services
• Increase service capacity through transformation

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MHSA INNOVATIONS (INN) COUNTY OF LOS
ANGELES-DEPARTMENT OF MENTAL HEALTHAN OVERVIEW
OF PURPOSE, REQUIREMENTS AND DEVELOPMENT OF
INNOVATION WORK PLANS

• Community Program Planning Process (CPP)
• The Department solicited innovative strategies
  from the public
• 105 strategies were received
• Three focal population workgroups (homeless,
  uninsured, UREP) of a wide variety of
  stakeholders were formed
• The workgroup members reviewed their focal
  population strategies and used them to develop up
  to five strategies
• An Integration Review Team made up of members of
  the three workgroups are integrating the 15
  strategies from the workgroups to develop the
  plan
• A draft work plan will be circulated for review
  and comment for at least 30 days and reviewed
  during a public hearing conducted by the local
  Mental Health Board

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CONTACT

• Maria Funk
• Mental Health Clinical District Chief
• Department of Mental Health
• 695 S. Vermont Ave., Room 808
• Los Angeles, CA 90005
• [phone]
• mfunk_at_dmh.lacounty.gov

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PROJECT-BASED SERVICES VOUCHERS

• A proposal to the LA County Dept. of Mental
  Healths Innovation program under the Mental
  Health Services Act
• Proposed by the
• Supportive Housing Alliance of
• Los Angeles

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PROJECT-BASED SERVICES VOUCHERS

• THE ISSUE
• THE NEED
• THE PROPOSED SOLUTION
• THE PROJECTED RESULTS

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The issue

• Homeless individuals and families struggling
  with mental illness are greatly underserved by
  the existing system of care
• There is no formal mechanism in place in LA
  County to link MHSA services in permanent
  supportive housing (PSH)
• Supportive housing developers have found it
  difficult to secure adequate MHSA services for
  homeless populations
• There is little incentive for PSH developers to
  target new housing for homeless populations
  without a reliable and sustainable source of
  services for homeless individuals and families

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What do we need/want?

• A mechanism that by its nature, encourages
  collaboration between service providers and PSH
  developers to benefit homeless pops.
• A mechanism that is easily understood by both
  parties and by LA County DMH
• An instrument that can leverage housing capital
  to help create more PSH
• A mechanism that is flexible, to benefit any
  PSH type single site, scattered site, large or
  small projects, mixed income, families or
  individuals.
• A program that will greatly improve outcomes
  for underserved homeless populations

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PROJECT-BASED SERVICES VOUCHERS What is it?
Whats the process?

• LA County DMH sets aside MHSA funds for this
  purpose through the 2-year Innovations program
• Developers competitively apply for X units
  valued at Y dollars/person/year for MHSA focal
  populations in specific PSH units the developer
  may or may not already have a service provider in
  mind when applying
• DMH makes awards based on a series of criteria
  TBD
• The award is in the form of a service
  allocation that can only be redeemed by a DMH
  contract agency, DMH clinic, or DMH Medi-Cal
  certified agency, but not the PSH developer.

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PROJECT-BASED SERVICES VOUCHERS (cont.)

• If the developer does not already have a
  committed service provider, then it shops for a
  provider to utilize the services voucherDMH
  could potentially assist.
• Developer and service provider agree to a
  services plan for the targeted population for
  specified number of units. The services will not
  be provided elsewhere or for a different
  population
• The PSH developer, the contract agency and DMH
  execute a tri-party contract, setting up roles
  and responsibilities.

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PROJECT-BASED SERVICES VOUCHERS (cont.)

• When the PSH units are placed in service, the
  service provider delivers the services, handles
  the billing, bill Medi-Cal as needed, etc. The
  developer signs off on the billing.
• For the Innovations process, significant
  coordination and evaluation measures are built
  into the proposal.
• If PBSV proves to be an effective mechanism,
  then it could potentially become part of the
  ongoing Community Services and Supports  (CSS)
  plan however,
• Projected MHSA revenues are expected to
  decline significantly in the next few year due to
  recession.
• The proposal is subject to revision via the
  Innovations process.

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Projected goals and outcomes

• The overarching goals of the PBSV project are
• To provide subsidized quality, affordable housing
  and integrated, highly accessible and responsive
  supportive services to formerly homeless families
  and individuals to support their ability to
  maintain housing, recovery, wellness, and
  resiliency.
• To create a replicable model for sustainably
  funding mental health and other supportive
  services in subsidized permanent housing for
  homeless individuals and families living with
  mental illness and other disabilities.
• To create a replicable model of collaboration
  among service providers and housing developers to
  provide permanent supportive housing for homeless
  individuals and families living with mental
  illness and other disabilities.

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Projected goals and outcomes (cont.)

• Projected outcomes are
• Residents achieve residential stability.
• Residents achieve greater well-being in the areas
  of mental health, substance abuse, and physical
  health.
• Residents increase involvement in self-help, peer
  support, and community building activities.
• Residents increase their income through benefits
  advocacy, education, vocational training, and
  employment.

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CONTACT

• Mike Alvidrez
• Executive Director
• Skid Row Housing Trust
• 1317 East Seventh Street
• Los Angeles, CA 90021
• [phone] ext. 113
• mike_at_skidrow.org

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Housing Works Mobile Integrated Services
Team(MIST)

• To succeed you needeffective linkages that can
  withstand conflict and challenge. Mollie Lowery
• Positive challenges strengthen the bond between
  partners

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WHAT THE MIST DOES

• Street and shelter outreach to chronically
  homeless persons diagnosed with serious mental
  illness- focus helping them into permanent
  housing finding a home
• Providing on-going, on-site supportive services
  to help tenants sustain their housing and thrive
  in their new community
• Eviction/Homeless Prevention (ACOF
  collaborative)- accepting referrals of
  tenants-at-risk-of-eviction providing
  intervention and augmented support services to
  help tenants sustain their housing and thrive

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ACOF /Housing Works Collaborative

• A Community of Friends (ACOF)
• To develop affordable housing and to
  collaborate with community-based service agencies
  in offering residents a variety of on-site
  supportive services.
• Housing Works
• To create housing options that model, with
  respect and dignity, sustainable, environmentally
  sensitive, affordable communities that provide
  equal and fair access to housing and human
  services for people with a limited income.
• The John Stewart Company (JSCo)
• Seeks challenging opportunities to bring
  new life to neighborhoods and new hope to
  families in search of a place to call home.

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PHILOSOPHICAL AND THEORETICAL PRINCIPLES

• Housing is a service- A FIRST Response
• Social Environment- Safe and Healthy
• Model Positive Behaviors
• Its the Behavior not the Person
• Non-Judgmental, Tolerant, and Accessible
• Forgiveness
• Individualized, Adaptive and Flexible

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• Housing is a Service- a FIRST response
• Housing is the first and most basic service.
  Having a home BEGINS the journey toward recovery.
• Social Environment
• Lasting and healthy change- the ability to
  thrive- comes about in a safe, reliable,
  empowering, and trusting environment. An
  effective supportive housing TEAM works together
  to create this environment.

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• Model Positive Behaviors
• The supportive housing TEAM members recognize
  that their behaviors are frequently used as a
  reference point for tenants to measure the
  appropriateness of their own behavior that they
  can influence tenant self perception.
• Its the Behavior not the Person
• Unconditional positive regard
• Boundary enforcement must always focus on the
  
  behavior.

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• Non-Judgmental, Tolerant and Accessible
• Understanding the social forces (race, class,
  gender, poverty, stigma of mental illness) that
  elicit behavior helps members of the supportive
  housing TEAM become more tolerant,
  non-judgmental, and skilled in building a fully
  accessible, inclusive community and housing
  environment.
• Forgiveness
• The willingness to try again- give SUCCESS
  a chance. Focus on the assets tenants have!
• Adaptive and Flexible
• Support services, the housing team, and the
  agency bureaucracies need to be adaptive and
  flexible.

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CONTACT INFORMATION

• Celina Alvarez
• Case Manager
• Housing Works Mobile Integrated Service Team
  (MIST)
• calvarez_at_housingworksca.org
• [phone]
• www.housingworksca.org

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MHSA InnovationsJUST IN REACH (JIR)Alternatives
to Incarceration

• Eimago Inc.

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Just In Reach MHSA Innovations

• The Just In Reach Program (JIR) strategy is
  designed to create an innovative model for
  reentry services for homeless inmates that would
  otherwise not have a safety net upon release.
• This model is intended to have a broad reach that
  will allow us to leverage other funding sources
  to ensure sustainability.
• A variation of this model has been piloted since
  2008 with a similar concept that leverages a
  wealth of resources including The Los Angeles
  County Sheriffs Department, Corporation for
  Supportive Housing, Second Chance Act, and five
  well-established service partners. Eimago Inc.
  is the lead agency and the pilot was funded
  through the Countys Homeless Prevention
  Initiative.
• This approach is a ground-breaking effort at
  strategic reentry planning for Los Angeles. The
  goal of all stakeholders is to improve discharge
  planning for homeless individuals who are
  repeatedly cycling through the Criminal Justice
  and County jail system, as a result of their
  homelessness.
• The goal is also to prevent, as much as possible,
  the occurrence of homeless individuals leaving
  the jail and ending up on Skid Row in downtown
  Los Angeles.

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Just In Reach Target Population

• The JIR Program is dedicated to assisting
  homeless individuals who are reentering their
  community upon release from the County Jail.
• Eligibility Criteria
• Homeless and incarcerated
• Individuals who have been in jail 3 times within
  3 years
• Individuals who have stayed in shelters 3 times
  within the last 5 years.

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Just In Reach Program Components

• Individuals with a mental health diagnoses will
  be referred by the Sheriffs Community Transition
  Unit (CTU) to the Department of Mental Healths
  discharge planning unit as well as the JIR
  program for collaborative assessment.
• JIR provides a full array of support services
  both in the County jail and upon release with a
  critical support plan that follows the individual
  for one-year post release.
• The commitment is to serve these individuals with
  whatever it takes to find appropriate housing,
  new job skills, a mentor, benefits advocacy and
  to motivate them to take advantage of the
  services available to them.

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Just In ReachOutcomes for Participants

• 1) significantly reduced recidivism rates and
  contact with the criminal justice system
• 2) an increased perception of their unique place
  in the community and contributions
• 3) greater expression in employment readiness
  and job retention
• 4) greater long-term housing retention
• 5) less need for intensive counseling
• 6) less depressive and anxiety symptoms, greater
  purpose, hope and sense of life satisfaction.
• The goals of preventing the occurrence of
  homeless individuals from leaving the jail and
  ending up on Skid Row in downtown Los Angeles
  will be attained through the research,
  development and implementation of this innovative
  program design.

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Just In Reach ProgramPilot Statistics

• LA Sheriffs Department reports that 70 of the
  general population cycles back through the County
  jail within one year
• The JIR comparison data shows a 29 recidivism
  rate within one year for this hardest to serve
  JIR population.
• Over a one-year period JIR has assisted in the
  short- and long- term housing placements of 156
  clients
• JIR clients who do not return to jail will result
  in a tremendous savings to the County each year.
  The cost to the County to provide services within
  the Just In Reach network is a little over 10
  per day on average or 3,750 per year.
• If 71 of JIR clients stay out of jail, this
  quick and dirty analysis translates to a savings
  of ((142 clients x 95/day)365) 4,923,850 at
  the most conservative projections.
• These projections do not include the other
  related costs for processing someone through the
  criminal justice system, police intervention,
  judge/court costs, incarceration processing,
  healthcare, public benefits, etc.

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CONTACT

• Bert Paras
• Program Manager, EIMAGO Inc.
• 545 S. San Pedro Street
• Los Angeles, CA 90013
• [phone]
• bparas_at_eimago.org

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ADDITIONAL MATERIAL

• For copies of the proposed innovations contact
• Neil McGuffin
• Associate Director, LA Office
• Corporation for Supportive Housing
• 800 S. Figueroa St., Suite 790
• Los Angeles, Ca. 90017
• 213-623-4342 x. 107
• Neil.mcguffin_at_csh.org
• www.csh.org