ADOPTED MINUTES
Mental Health Board
Wednesday, February 11, 2009
City Hall, Room 278
San Francisco, CA
BOARD MEMBERS PRESENT: James L. McGhee (Chair); Jagruti Shukla, MD, MPH (Vice- Chair); James Shaye Keys (Secretary); Tom Purvis (telephone conference); Njoroge Tho-Biaz, MA; Hale M. Thompson; and Virginia Wright.
BOARD MEMBERS ABSENT: John Kevin Hines; Officer Kelly Dunn; LaVaughn Kellum King;
BOARD MEMBERS ON LEAVE: M. Lara Siazon Arguelles; Bridgett Brown; and Lisa Williams.
OTHERS PRESENT: Dr. Robert Cabaj, Director of Community Behavior Health Services (CBHS); Helynna Brooke (MHB Executive Director); Loy M. Proffitt (MHB Administrator); Craig Murdock, MPH, Program Director of Behavior Health Access Center (BHAC); Naomi Marcus, UCSF Psychiatry; Errol Wishom, MHB Applicant, UCSF Citywide; Ralph Fenn, Family Service Agency (FSA).
CALL TO ORDER
The meeting was called to order at 6:40 PM. by James L. McGhee, Chair.
ROLL CALL
Ms. Brooke called the roll.
AGENDA CHANGES
No agenda changes were made.
ITEM 1.0 DIRECTORS REPORT
Mr. McGhee: Dr. Bob Cabaj, the Director of Community Behavioral Health Services (CBHS), will give the Director s report and then follow that with a presentation of the current state of budget cuts and its impact on services.
Dr. Cabaj: We have been reminded of client confidentiality. This means privacy issues are applicable to former clients and patients including the deceased, as well.
The Behavior Health Court (BHC) program is very effective, according to a study that began in 2005. There will be a special presentation on Wednesday May 20, 2009 at the Sheriff s Conference Room. The address is 425-7th Street, San Francisco.
We just reported the unduplicated client counts from October to December 2009, as mandated by the Mental Health Services Act (MHSA). The report shows three general groups: Full Service Partnership (FSP), General System Development, and Outreach, and the total count is 5,714 unduplicated clients served.
The Prevention and Early Intervention Plan (PEI) is being reviewed by the State Department of Mental Health (DMH), meaning the State has 30 days to approve the Plan. Today, the San Francisco Board of Supervisors was presented with the PEI Plan.
Mr. Keys: I learned that you submitted a special resolution to Supervisor Avalos regarding opposition to the governor taking the Proposition 63 (MHSA) money to balance the state budget.
Dr. Cabaj: Every organization is against that. I appreciate your support on not allowing the governor to take the Proposition 63 money.
Mr. Keys: Can you report back to us when you will be creating the Request for Proposal (RFP) task force?
Dr. Cabaj: Yes, I have planned to keep the board abreast of the progress. I believe it should start this March.
Monthly Director s Report
January 14, 2008
Private Policy
Please distribute widely.
There was a recent and serious breach of confidentiality by individuals both within DPH and our contractors/affiliates. Please review the following privacy reminders regarding protected health information about our clients and patients. If your program works with contractors, affiliates or partners with Memorandum of Understandings (MOUs), please take time to remind them of the importance of adhering to DPH privacy policies, especially when talking to reporters.
Please note, per DPH Privacy Policy:
Directive to DPH workforce, contractors, affiliates, partners with MOUs with the DPH:
Directive to DPH Workforce:
Further information inside DPH intranet: http://dphnet/Privacy/default.htm
Further information outside DPH public website:
http://www.sfdph.org/dph/comupg/oservices/medSvs/HIPAA/default.asp
If you have any questions, please feel free to contact your DPH Privacy Officer:
DPH Privacy Board:
A study of San Francisco's Behavioral Health Court that began in 2005 is concluding its first phase, showing positive outcomes. The study sought to determine the effectiveness of mental health courts (MHC) in improving public safety outcomes and treatment engagement among people enrolled in these specialty courts. The study includes 4 sites San Francisco and Santa Clara Counties in California, Hennepin County (Minneapolis) in Minnesota, and Marion County (Indianapolis) in Indiana. These 4 sites were chosen in part because they meet the overall criteria for what comprises a mental health court. In each site, the researchers interviewed and followed a sample of MHC subjects and a similar sample of treatment as usual (TAU) jail subjects those who met the criteria for MHC but were not enrolled. Other objective data on treatment received, jail stays, and arrests were also collected for all subjects in the study.
Preliminary findings indicate that arrests in the 18 month follow-up period are significantly reduced for MHC clients as compared to the TAU samples in all 4 mental health courts. This is especially true for arrests involving a person, in distinction to property crime. In addition, the study has found that in all 4 sites, the time between release from jail on the target arrest and time to re-arrest is longer for MHC clients than for TAU clients. In terms of jail stays, MHC clients experience a significant reduction in the number and length of jail stays compared with TAU clients. Of additional interest is the finding that MHC clients report more community treatment engagement than do TAU clients. While it is not possible at this time to form a cause/effect relationship between treatment and improvement in public safety outcomes for MHC clients, the relationship is important and being further explored.
Two of the researchers, Henry J. Steadman, Ph.D. and Lisa Callahan, Ph.D., from Policy Research Associates, Inc. will present findings from the national study with a spotlight on San Francisco on May 20, Wednesday, 12 noon - 1:30 pm at the Sheriff's Conference Room - County Jail # 8, at 425 7th St., 1st floor, San Francisco.
Continued funding has been received from the John D. and Catherine T. MacArthur Foundation for the second phase of the research to study the costs of mental health courts, comparing the costs and benefits of the specialty courts with typical criminal court procedures for these defendants. The continued cooperation and partnership with all 4 sites will expand our knowledge about the beneficial effects of mental health courts as well as the financial costs and benefits of these specialty courts.
UNDUPLICATED CLIENT COUNTS FOR THE SECOND QUARTER IN FISCAL YEAR 2008-2009
Counties are mandated to report their unduplicated client counts every quarter to the Department of Mental Health. To date, all of the MHSA funded agencies have met their projections for the second half of the fiscal year. The recent count for San Francisco is reflected in the following table:
CLARIFICATIONS REGARDING ALLOWABLE USE OF FULL SERVICE PARTNERSHIP (FSP) FUNDS FOR FY 2009/10
The Department of Mental Health (DMH) will issue guidelines effective immediately which clarify expanded interpretation of FSP definition of priority population. In this new interpretation, the following individuals would now be eligible for FSP services: (1) Individuals currently living in Board and Care homes and residential care facilities for the elderly (RCF-E); (2) Individuals/families who would be otherwise homeless or at risk of homelessness if they did not have their extended family caregivers and/or other caregivers; (3) Individuals/families who met the initial criteria for intensive case management at entry in the FSP and no longer need the same level of intensive services may remain in FSP programs; and (4) Individuals entering FSPs can enter at any level of or with an array of services that meet their wants/needs as long as regulations are met.
For Child and TAY (Transitional Age Youth) FSPs, guidelines have also been expanded to include (1) Children/families who have no sources of funding for mental health services; (2) Children/families who are eligible for funding services such as EPSDT or AB3632 funding but need/want services beyond those funded under these sources; (3) Children/families who have full funding for children s services but who do not have other funding for services for needs/wants of parents/caregivers.
What this means is that larger numbers of programs, services, and client populations will now qualify for funding under the Mental Health Services Act. With restrictions lifted and elimination of tiered services set to begin, an argument can be made that this constitutes a violation of the letter and intent of the original Proposition 63 language. However, in an era of deepening budget deficits and projected revenue shortfalls, the spirit of making available services to as many deserving clients as possible can now be achievable within the expanded parameters of the Act.
PREVENTION AND EARLY INTERVENTION PLAN MOVES FORWARD
The San Francisco Prevention and Early Intervention (PEI) Plan has been sent to the Department of Mental Health for review. The DMH has 30 days to approve the Plan, followed by a 60-day review process by the Mental Health Oversight and Accountability Commission. Simultaneously, the San Francisco Board of Supervisors will be presented with the Plan on February 11, 2009, submitted for their approval. The entire review and approval process should be completed, hopefully, by early June.
INFORMATION TECHNOLOGY (IT) COMMUNITY PLANNING COMMITTEE CONTINUES TO MAKE PROGRESS
The second meeting of the Information Technology Planning Committee took place on January 29, 2009, at RAMS HireAbility, 1234 Indiana Street, from 3-5 pm. The purpose of this meeting was to brainstorm new and innovative ideas regarding the usage of the anticipated funding for IT purposes, to be analyzed and considered by the committee for inclusion in the finalized Plan. Dates reserved for future meetings include Tuesday, February 24; Tuesday March 10; and Tuesday, March 24; with the locations as yet to be determined. The public is cordially invited to attend. To receive more information as it becomes available, please contact Frank Isidro, Co-Chair, (415) 255-3572, frank.isidro@sfdph.org
CAPITAL FACILITIES PLANNING COMMITTEE PROCESS SET TO BEGIN
Three meetings of the Capital Facilities Planning Committee are set to take place on Tuesday, February 24, 11:30 am 1 pm, at Friendship House, 56 Julian Street; Thursday, February 26, 9 11 am, Location:TBD; and Friday, February 27, 3 5 pm, Location: TBD. Further information will be posted as it becomes available.
MHSA ADVISORY COMMITTEE MEETINGS:
The Mental Health Services Act Advisory Committee meets bi-monthly from 3-5 pm, alternating between advisory meetings and community forums. The next scheduled meetings are:
Wednesday, February 18, 2009 Thursday, April 16, 2009
Advisory Committee Community Forum
1380 Howard Street TBD
San Francisco, CA 94103
AFRICAN AMERICAN ISSUES IN HEALTH IX- Friday, February 20, 2009
Saint Mary s Conference Center. The African American Issues in Health IX conference will highlight cultural competency for African Americans throughout a continuum of care. Clinicians and practitioners will reflect on how historical and personal beliefs impact the engagement and treatment of African American clients and their overall plan of care.
The conference will focus on existing and emerging best practice strategies for providing culturally appropriate health services for African American consumers and family members and identify ways for African Americans in San Francisco to access the most effective care that promotes wellness, recovery, and resiliency. Registration for this conference is closed.
For more information on upcoming trainings and conferences, please contact
Norman.Aleman, CBHS Training Coordinator at 415-255-3553 or email
norman.aleman@sfdph.org
___________________________________________________________________________
Past issues of the CBHS Monthly Director s Report are available at:http://www.sfdph.org/dph/comupg/oservices/mentalHlth/CBHS/CBHSdirRpts.asp
To receive this Monthly Report via e-mail, please e-mail richelle-lynn.mojica@sfdph.org
The Current State of Budget Cuts and Its Impact on Services
Dr. Cabaj: As I mentioned at the January 14th meeting, I would like to keep the board abreast of the budget cuts and its impact on services.
The Obama administration is in the final process of an economic stimulus package. We expect the coming funds from the federal government to match funding for Medical. California has the lowest federal fund matching in the Union. California currently receives only fifty-cents per dollar in Medical match. But the State could receive a 30% increase to sixty-five cents per dollar, after the Federal government s economic stimulus package is passed. This increase is on par with most of the other states in the Union. We could get a permanent match of $9M-$17M per year.
At the San Francisco City and County level, the budget cut has reached $50M. Beyond that amount; there is a contingency amount that also might be cut. The Health Commissioners heard a round of cuts at last Tuesday s meeting, on February 10, 2009, and will hear more about cuts next Tuesday. The proposed budget, including the details, should be available on the Department of Public Health (DPH) or the Health Commission web sites this Friday, February 13, 2009.
In this second budget cut, fewer services are needed to be cut. This is a way to keep the same case manager for a client, through whatever program they go to. However, the methadone detoxification program was eliminated. The decision to cut this program was partly due to lack of success, because we have found that clients respond to treatment better with the methadone maintenance program. There were also reduced cuts to the Westside Clinic, which contains Westside Crisis and Westside Outpatient Clinic. Administrative cuts were necessary to preserve mental health services and clinical staff.
Dr. Shukla: How much are the cuts to CBHS?
Dr. Cabaj: There is about $20M. A majority of the cuts were in administration. There was a 5% cut across the board in mental health services and a 25% cut for substance abuse services because they are primarily funded by the general fund.
Dr. Shukla: Are there other programs being cut in entirety?
Dr. Cabaj: I do not recall any specific names because there are irresolvable conflicts in deciding which programs to be eliminated. I know discussions have been mostly about cutting the outreach modality as another option. The hope is that new money for prevention would be allocated to provide better use of scarce resources.
Mr. Purvis: Are there further cuts expected next year?
Dr. Cabaj: There is an expectation of another year of recession. We can only have contingency plans. It is probable that we might be able to coast to the next year with minimum cuts. There is an ongoing restructuring of primary care. Next year s budget is an ongoing planning process.
At this time, the State s budget crisis has not yet resolved. Cash flows are still the big issue. Legislators are negotiating.
There have been other considerations for generating revenues, possibly for some programs such as Iris Center to be able to bill Medical. We are looking at generating revenue by doing MediCal billing to off set costs and keep Iris accessible.
Mr. Keys: Thank you for your presentation on the budget. I have been meeting with Dr. Mitch Katz and San Francisco Supervisor John Avalos. Your presentation seems brighter that what I have been hearing. Thank you for trying to maintain a safety net for those in need.
Dr. Cabaj: In underserved communities, there are too many families not to mention the uninsured and underinsured who need access to services. I want to ensure that we offer quality prevention, education, and behavioral health services to the people of San Francisco.
Mr. Keys: What is the time frame we can expect from the Federal government s economic stimulus package?
Dr. Cabaj: The Wall Street Journal has been reporting about the $787 billion stimulus bill. I am hoping to notice the benefits from the bill in the spring. And I hope the funding will be retroactive back to October 2008.
1.2 Public comment relevant to Item 1.0
No public comments.
ITEM 2.0 PRESENTATION: CBHS ACCESS PROGRAM by Craig Murdock, MPH, Program Director
2.1 Presentation:
Mr. Murdock: I m the director of the Behavior Health Access Center (BHAC). BHAC moved in on September 1, 2008 to the first floor of 1380 Howard. BHAC is co-located with five integrative programs to provide behavior health services designed to be holistic. The programs are Treatment Access Program (TAP); Mental Health Access Program (MHAP) which is a private provider network and has received support from DPH; Buprenorphine Induction Clinic, which provides treatments for opiate addiction; Narcotic Replacement Treatment (NRT), which provides methadone replacement for people who were discharged from San Francisco General Hospital (SFGH); and the CBHS pharmacy, which is a complementary program to dispense medications.
Prior to opening BHAC, there was very little patient-interaction or face-to-face consultations at 1380 Howard. There were unfounded fears in the building regarding clients wandering around the building, which has been functioning primarily as the administrative center for accounting, contracts and grants. It was a challenge integrating into the building due to security concerns. But most of those concerns were ameliorated.
BHAC is co-existing as the one-stop center for mental health services on the first floor and clients are not wandering through other floors to obtain services because the first floor is dedicated to mental health care and treatment. On the first day of the opening, we saw 52 patients face-to-face.
We had an incidence today, and the San Francisco police took a person into custody and delivered that person to San Francisco General Hospital. There were no concerns from the neighbors.
Mr. Keys: Is there support training for staff at 1380 Howard like the Police Crisis Intervention Training (PCIT) program?
Mr. Murdock: We are trying to create an environment on the first floor that works well for clients where they mostly do not need to go to other floors because all the programs and pharmacy are located on the first floor. We saw 621 unduplicated clients seeking substance abuse and mental health services.
The Mental Health Board had heard of complaints about mental health access. Several years ago, the City experienced failures from the program, lack of funding partly contributed to the problem. Another was that most of the staff were from other City departments, and there were some troubled staff. We took corrective steps and implemented guidelines. There were terminations and some grievances filed. We managed to secure two additional eligibility workers to generate more revenue.
There is still a considerable amount of work left to do. They are working on reducing the number of dropped telephone calls. The drop rate has reduced by 44%. The other is reducing wait-time by having everyone pick up calls and forward clients messages to appropriate personnel. The wait time has reduced from 22 minutes to 4 minutes.
Since October 2008, we have people seeing patients face to face rather than telephonically. Patients in crisis can sit with counselors or social workers who can do assessments and can place patients into appropriate services. We are working on training as another way to increase clinical depth for staff on both mental health and substance abuse issues.
Mr. Keys: Thank you for being candid with the board. How does the inclusion of Healthy San Francisco affect BHAC now?
Mr. Murdock: We do not have primary care officially, meaning we include medical depth for patients with primary care concerns. We have the capability to enroll people in Healthy SF and to help people extend their 20 session therapy. The 20 session limit has been a big challenge.
Dr. Shukla: I appreciate you remembering the board s concerns. Can you talk more about how people have access to staff for services, including patients access to the program itself? Also, what percentage of the people walking in for help actually receive mental health services?
Mr. Murdock: We have over 600 clients with an average of five walk-in clients per day. That average does not include people who stopped by with questions. We have had 1700 duplicated clients.
Dr. Shukla: What percentage of clients coming in is not connecting to services?
Mr. Murdock: Our policy is to make sure that clients leave with at least a referral, whether for a pre-treatment group or placement. Sometimes there are waiting lists such as residential care. We also have system navigators who work part-time to escort clients to nearby appointments. For example, we go with clients to the Social Security Administration (SSA) to help them get social security income (SSI). There were times we escorted them to the Department of Motor Vehicles (DMV) to obtain personal identification cards.
In substance abuse treatment, we have not succeeded in yielding revenue. We are working on ways to do that.
Mr. Purvis: What services are reimbursable?
Mr. Murdock: We receive very little reimbursement from Medical and SSI for providing mental health services.
Ms. Wright: What kind of eligibilities?
Mr. Murdock: We can inquire about ability to pay for services, but we do not deny services to indigent people. We have 27 staff who can speak 11 languages. We believe in any door the right door for individuals in need of treatment of substance use and/or mental health treatment.
2.2 Public comment relevant to Item 2.0
No public comments.
ITEM 3.0 ACTION ITEMS
3.1. Public comment
No public comments.
3.2. Resolutions
3.2. a RESOLUTION: Be it resolved that the minutes of the Mental Health Board meeting of January 14, 2008 be approved as submitted.
There was no quorum so no vote was taken.
ITEM 4.0 REPORTS
4.1 Report from the Executive Director of the Mental Health Board.
4.2 Report of the Chair of the Board and the Executive Committee:
Mr. McGhee: I attended a non-profit breakfast at the City Club. I also participated on The Workgroup 6 - CBOs which is a community focus group evaluating the merger of CBOs and their effects on services and community. There were close to 100 people there, and people broke out into six different groups. Some major concerns were funding cut-backs and multi-cultural programs being eliminated.
4.3 Report by Members of the Board on Their Activities on Behalf of the Board.
Mr. Keys: I have been following up with Barbara Garcia who is the Deputy Director of Health for the DPH. Her staff have not yet responded to my request to participate on various committees so I can be part of the DPH budget process.
4.4 New business - Suggestions for future agenda items to be referred to the Executive Committee.
Mr. McGhee: I would like to invite the four new supervisors to come to speak to our board.
Dr. Shukla: I would like to learn more specifically about what programs are being cut. I need to be able to evaluate the impact of these cut and how the cuts affect services. I am concerned that some programs may become eliminated and become extinct.
Mr. Keys: I would like to explore strategic options on how we can advocate to state legislators to distribute Proposition 63 money to California counties before the governor gets it.
4.5 Public comment relevant to Item 3.0
No public comments.
ITEM 5.0 PUBLIC COMMENT
No public comments.
Adjournment
Meeting adjourned at 8:29 PM.