May 2, 2023
HONORABLE MAYOR AND CITY COUNCIL
City of Long Beach
California
RECOMMENDATION:
Receive and file a report from the Health and Human Services Department regarding the feasibility of establishing a more robust local infrastructure for mental health services. (Citywide)
DISCUSSION
On November 9, 2021, the City Council requested the City Manager to work with the Health and Human Services Department (Health Department) and local mental health providers to explore the feasibility of establishing a more robust infrastructure for mental health services, in collaboration and alignment with local mental health providers in Long Beach and the County of Los Angeles. On February 8, 2022, the City Council approved $100,000 of General Fund one-time funds to lead the mental health study efforts. These funds were utilized to convene a Mental Health Advisory Group and retain a consultant with specific expertise in mental health funding mechanisms, data, service delivery, and referral pathways to conduct a feasibility study and move this effort forward.
The Health Department convened a Mental Health Advisory Group which consisted of a diverse cross-section of local hospitals, education systems, homeless services providers, non-profit organizations, mental health providers, and relevant Los Angeles County departments. This Mental Health Advisory Group convened six times since May 2022. The Advisory Group participated in identifying gaps and solutions, enhancing communication, and identifying potential resources. City staff also engaged in active conversations with the Los Angeles County Department of Mental Health regarding existing service provision and systemic challenges.
The Health Department also contracted with Capstone Consulting Group to:
1. Educate policymakers regarding behavioral health programs including options and constraints for pursuing enhanced residential treatment programming including:
a. Ensuring understanding of the multiple systems that comprise the behavioral health system in Los Angeles County including the specialty and non-specialty mental health systems and the substance abuse disorder continuum of services, b. Promoting recognition of the various levels and types of intensive residential treatment programs available in California with an explanation of the programmatic, regulatory, and funding considerations that accompany each level of care, and Health and Human Services
2525 Grand Avenue, Long Beach, CA 90815
(562) 570-4000
R-32
HONORABLE MAYOR AND CITY COUNCIL
May 2, 2023
c. Providing a knowledge base of funding streams and how those can be utilized to maintain and expand services.
2. Identify existing options and capacity for behavioral health treatment at the different levels.
3. Detail approaches to sharing information, including electronic data sharing, to improve access and coordination of care.
4. Generate alternatives for the expansion of capacity with a strategic action plan for the implementation of feasible alternatives.
As a result of these efforts, we are pleased to present the attached Developing a Robust Mental Health System in Long Beach Report (Report). The vision of the Report is that all community members have an open path to access and receive the mental health support they need to thrive. The Report highlights four focus areas designed to enhance the local mental health system:
1. Mental Health Treatment Capacity
2. Prevention
3. Access to Treatment
4. Focus Populations
Within these broader themes, there are strategies and proposed action steps to guide, focus and prioritize activities to enhance the local mental health system. These findings will serve as the foundation for systemic improvements in Long Beach related to mental health.
This matter was reviewed by Deputy City Attorney Monica Kilaita on March 27, 2023, and by Budget Analysis Officer Greg Sorenson on March 31, 2023.
TIMING CONSIDERATIONS
City Council action on this item is not time critical.
FISCAL IMPACT
The total cost to conduct the feasibility of establishing a more robust local Infrastructure for mental health services did not exceed $100,000 and was allocated to the General Fund Group in the Health and Human Services Department, using Fiscal Year 2021 General Fund Group year-end funds available. This recommendation has no staffing impact beyond the normal budgeted scope of duties and is consistent with existing City Council priorities. There is no fiscal or local job impact associated with this recommendation. However, implementation of the strategies and proposed action steps could have a significant fiscal impact and outside funding would need to be provided to be able to move forward with many of the recommendations.
HONORABLE MAYOR AND CITY COUNCIL
May 2, 2023
SUGGESTED ACTION:
Approve recommendation.
Respectfully submitted,
KELLY COLOPY
DIRECTOR
HEALTH AND HUMAN SERVICES
Attachment
APPROVED:
_______________________
THOMAS B. MODICA
CITY MANAGER
Developing a Robust Mental
Health System in Long Beach
April 2023
Table of Contents
3Introduction
9Executive Summary
20Focus Areas and Recommendations
25Section 2: Prevention
33Section 4: Focus Populations
4Our Approach
11Setting the Context
21Section 1: Mental Health Treatment Capacity
27Section 3: Access to Treatment
1 37Attachments
37 50
59 62
64 65
66 78
Attachment A - Capstone Solutions Consulting Group
Presentation on the Behavioral Health System of Care
Attachment B - Long Beach Mental Health Resource Guide
Attachment C - Summary Results of a Provider
Survey in Long Beach
Attachment D - Description of Data-Sharing Strategies
Attachment E - Level of Care with Definitions
Attachment F - List of Abbreviations
Attachment G - Capstone Solutions Consulting Group
Presentation: Intensive Behavioral Health Services in Long Beach Attachment H - Mental Health Advisory Group Timeline
of Recommendations
80Acknowledgments
2 Introduction
For more than 100 years, the Long Beach Department of Health and Human Services (DHHS) has been a staunch advocate for and protector of the Long Beach community’s health and well-being.
The DHHS has been closely following the mental and emotional health of community members for many decades and has launched campaigns to reduce stigma, integrated mental health supports into service settings, funded local Black mental health providers, and worked to connect people to the treatment they need across the lifespan. There has been growing urgency around meeting the community’s behavioral health needs given the strong connection between mental health conditions and substance use disorders and homelessness, educational attainment, economic success, and efforts to address public safety and violence. In short, optimal mental health and well-being are fundamental to achieving overall quality of life. The DHHS continues to work to meet the increased behavioral health needs of the community to realize the vision in which everyone within our diverse communities is safe, healthy, and has the resources to thrive.
On November 9, 2021, the Long Beach City Council directed the City Manager to work with the DHHS and local mental health providers to explore the feasibility of establishing a more robust infrastructure for mental health services in collaboration with the County of Los Angeles. In response to this directive, the DHHS began convening a Mental Health Advisory Group in May of 2022, and hosted meetings to obtain input regarding the strengths and challenges of the mental health system, focusing on the following populations of concern: children and youth in schools, adults living with depression and anxiety, people experiencing homelessness, and those in crisis.* Following the early convenings of the Mental Health Advisory Group, the DHHS entered into an agreement with Capstone Solutions Consulting Group (in October of 2022) to conduct a provider survey, provide technical information, and make recommendations that could support an enhanced mental health system in Long Beach. On January 10, 2023, the City Council proclaimed a state of emergency on homelessness. This proclamation added additional urgency to take immediate action where possible, and to formulate recommendations for the future. *Note: For the purposes of this report, we are defining crisis as an incident in which someone is experiencing intense feelings of personal distress, obvious changes in functioning, and/or catastrophic life events which may result in thoughts or actions that are dangerous to self and/or others. 3 Our Approach
Between May 2022 and February 2023, the DHHS convened and facilitated a planning process intended to develop recommendations for a more robust mental health system in Long Beach. This process included two parallel but related efforts.
The first effort was to engage an advisory group to inform the process. The Mental Health Advisory Group was comprised of representatives from Long Beach mental health provider agencies, homeless services agencies, business associations, LA County departments, local hospitals, and educational institutions. It was formed to identify barriers and opportunities for enhancing the mental health system based on participants’ experiences. During the first convening, group members elected to focus on ease of access, workforce development and capacity, funding, coordination, and data/data sharing.
The following central themes emerged from the conversations held with the Mental Health Advisory Group:
4 In Long Beach, all community
members have an open path to
access and receive the mental health
support they need to thrive.
Group members also anchored their work in the following vision statement and principles:
• The mental health workforce is sufficient to meet the need, healthy and supported by a foundation of sustainable funding, continuous professional development, and the implementation of trauma- informed and resiliency best practices.
• The mental health ecosystem is well-coordinated and responsive to the needs of the community by providing a “no wrong door” entry into care and establishing a shared language and unified data metrics across all providers.
During the series of convenings, Mental Health Advisory Group members provided information that highlighted numerous dimensions of the mental health system in Long Beach. In the first convening, group members identified barriers and provided recommendations for solutions in five focus areas:
time, resources, processes, prevention, and funding. In the second convening, group members provided information related to the phases of system navigation, and the strengths and opportunities for growth of the Los Angeles County Department of Mental Health (DMH) services. The following visual summaries were created and shared with group members for continued reference.
Principles
Mental Health Advisory Group Feedback
5 Identified Stengths & Successes
Identified Barriers & Opportunities for Growth
6 While the results of these two efforts will be detailed more comprehensively in the report, five key themes emerged:
1. The mental health system is complex and difficult to understand.
2. In a time of limited mental health resources, we must ensure that we maximize the use of existing capacity.
3. Mental health services must be expanded in a strategic manner.
4. Technology can be utilized to support coordination efforts and enhance services.
5. Community members do not access care for a variety of reasons including:
• Inadequate capacity of treatment programs
• Insufficient information regarding mental health disorders, resulting in failure to seek treatment • Paucity of information about treatment options available even when the problem is recognized • Lack of culturally affirming care on the part of treatment staff • Internal and external stigma
• Lack of or insufficient health insurance to cover the costs of treatment Additionally, the Mental Health Advisory Group identified actionable strategies that have been organized into an implementation plan by time frames: short-term (zero to six months), mid-term (six to 12 months), and long-term (12 to 24 months). The strategies are woven throughout this report and may be referenced in Attachment H.
The second effort was to engage a consulting group with expertise in mental health systems, Capstone Solutions Consulting Group, to provide information, make recommendations, and take strategic action in specific areas to support this effort. Their scope of work included anchoring the group’s understanding of the current landscape of mental health systems by providing education regarding the multiple systems, including intensive services.
The consultants were also asked to help capture existing local capacity, detail options for information sharing between providers to better coordinate care and identify strategies for new initiatives that could expand the mental health system for the following populations: children and youth in schools, adults living with depression and anxiety, people experiencing homelessness and those in crisis. They were also asked to assist with the technical aspects of expanding intensive and residential treatment services. The consulting group engaged with the Mental Health Advisory Group as well as the DMH, Substance Abuse Prevention and Control (SAPC), mental health providers, and data and funding experts.
The stakeholder process and the consultant’s work occurred simultaneously, which allowed for joint meetings and shared input in a bidirectional manner. The report that follows reflects the synergistic outcome of this collaborative effort.
7 8
Executive Summary
Mental health is fundamental to overall health and well-being. It is an essential component of any thriving city and, given the connection between the prevalence of mental health conditions and homelessness, public safety, educational attainment, and economic success, it is the right time to explore how mental health systems may be improved.
On November 9, 2021, the Long Beach City Council directed the City Manager to work with the DHHS and local mental health agencies to explore the feasibility of establishing a more robust mental health services infrastructure, in collaboration with the County of Los Angeles.
Between May 2022 and February 2023, the DHHS convened and facilitated a planning process to develop recommendations for a more robust mental health system in Long Beach. This process included two parallel but related efforts:
1. Convening an advisory group comprising representatives from Long Beach mental health service providers, homeless services agencies, business associations, County departments, local hospitals, and educational institutions to inform the recommendations.
2. Engaging a consulting group with expertise in mental health systems, Capstone Solutions Consulting Group, to provide technical information, make recommendations and take strategic action in specific areas to support the planning process. 9 The current structure of funding whereby mental health and substance use funds are dispersed to counties is dictated by State law so it is not feasible to fully localize mental health services. However, the DHHS has identified and laid out four focus areas and strategies for localizing the mental health system within its scope of control and authority. These focus areas are mental health treatment capacity, prevention, access to treatment, and focus populations. Each focus area contains goals and strategies that have been informed by the Mental Health Advisory Group and Capstone Solutions Consulting Group. The strategies are organized into three timeframes: accomplished, short-term, and long-term. The feasibility of these strategies and actions depends on identifying the substantial funding and staffing resources necessary to carry out the efforts.
Given the urgency and local, regional, State, and national attention on this issue, the DHHS stands ready to tackle the next steps as funding and capacity become available. Together with our partners, allies, and community members, the DHHS is prepared to serve as a leader, coordinator, convener, and advocate for growing and expanding the local mental health system.
10 Setting the Context
Over the last several years, awareness around the importance of mental health and substance use disorders has come into clear focus with nearly universal relevance. While the COVID-19 virus itself may cause brain- and mental health-related conditions, including cognitive and attention deficits (brain fog), anxiety and depression, psychoses, seizures, and suicidal ideation, much attention is also being paid to social isolation and how it affects individuals, families, and communities. In 2021, the United States Surgeon General, Dr. Vivek Murthy, released the report “Protecting Youth Mental Health” in which he underscored the importance of supporting the mental health of youth and marginalized people. At the State level, Governor Newsom’s administration has been working to support the behavioral health (which includes mental health and substance use disorders) of Californians with the following investments:
• $2.2 billion for the Behavioral Health Continuum Infrastructure Program. • $1.5 billion for Behavioral Health Bridge Housing.
• $1.4 billion to expand and diversify the behavioral health workforce. • $4.7 billion Master Plan for Kids’ Mental Health, of which the Children and Youth Behavioral Health Initiative is the central component.
• $1.4 billion to build out a Medi-Cal benefit for mobile crisis response, as well as $38 million to expand the 988 Suicide and Crisis Line and the CalHOPE crisis call center. • Over $600 million to support community-based alternatives to state hospitalization for those who have committed felonies but are incompetent to stand trial. • Over $1 billion to address the opioid epidemic.
• $7 billion to reform CalAIM to enhance care management for people with serious mental illness, a “no wrong door” approach to care, and more.
• $1.6 billion proposed to implement the California Behavioral Health Community-Based Continuum Demonstration to strengthen services and supports for those who are at risk of homelessness, incarceration, and foster care placements. • $50 million for the California Veterans Health Initiative (CVHI) for veteran suicide prevention and mental health services.
National and State Context
11 During the COVID-19 pandemic recovery phase, based on local data and input from community-based organizations that provided services during the pandemic, the DHHS made historic investments in central, west, and north Long Beach. In October of 2022, the DHHS issued over $3 million in funding to address factors that contributed to COVID-19 hospitalizations as well as the impacts of COVID-19, including mental health supports and trauma recovery. While these investments are significant, they are not enough.
The number of individuals with mental health conditions in cities throughout Los Angeles County continues to increase. The 2018 Los Angeles County Health Survey found that 42 percent of adults reported recent anxiety or depression and only 67 percent of adults visited a doctor for a routine checkup, potentially preventing the detection of mental health conditions which can lead to serious concerns. On average, about 15.8 percent of Long Beach residents 18 years and over reported not having good mental health for 14 days or more, with ZIP Code 90813 having the highest rate of reporting this issue. The majority of Long Beach residents receive their insurance through their employer (43.7 percent), followed by Medicaid/means-tested public coverage (23 percent) and 8.9 percent of Long Beach residents are uninsured, with the highest rates being in 90805 and 90813.
Data demonstrate an over-representation of our Black community in Long Beach visiting the emergency room for mental health conditions compared to other race/ethnicities. Our Black community visits the emergency room at a rate nearly double that of the city overall (603/10,000 adults compared to 322 per 10,000 adults). The CA Health Care Foundation (2019) found that American Indian adults had the highest percentage for serious mental illness (6.8 percent) compared to 5.3 percent for Black adults and 4.2 percent for White adults.
For youth, mental health concerns were exacerbated during COVID. The UCLA Center for Health Policy Research reports that the number of 18-to-24-year-olds in California who reported having suicidal ideation at some point in their lives increased to 30.5 percent in 2021 from 23.9 percent in 2020.
These figures represent a dramatic increase from just five years ago when the Center’s 2016 survey found that 14.1 percent of California’s young adults said they had experienced thoughts of suicide at some point in their lives.
According to the 2021 California Health Interview Survey, 36.7 percent of respondents aged 13 to 17 said they needed help for emotional or mental health problems, but 26.2 percent of them did not receive any counseling in the past year.
On March 19, 2023, Governor Newsom released his most recent proposal to further improve how California treats mental health conditions, substance use disorders, and homelessness. The proposal includes introducing a 2024 ballot initiative to develop a bond to build state-of-the-art residential treatment facilities in communities throughout the state. The proposal also includes creating housing for homeless veterans and modernizing the Mental Health Services Act (MHSA) to require at least $1 billion every year for behavioral health housing and care.
Local Context
12 13
14 While the focus of this report is on improving access to mental health services, we believe it is also important to include a discussion of substance use disorder prevention and treatment, as mental health conditions and substance use disorders (SUD) may be co-occurring and there are similar challenges with accessing treatment for both. For the purposes of this report, we use the term behavioral health when referring to both systems together, otherwise, we call out mental health or substance use disorders separately.
The mental health system serving Long Beach is a series of systems depending on a variety of factors.
These systems are not coordinated and there is little communication between systems that treat the same individuals or families. This makes accessing relevant services at the appropriate time very difficult. To successfully navigate the multiple entities that oversee care, clients must know their insurance or benefit status (Medi-Cal, Medicare, employer insurance, etc), what type of problem they are experiencing (mental health conditions, substance use disorders, or both), the severity of the problem (mild to moderate vs. serious), and whether they might be eligible for services delivered through another system (e.g., schools, child welfare, or probation).
Behavioral Health Systems Serving Long Beach
Mental Health
15 The following illustration of the behavioral health ecosystem in Long Beach provides a more complete picture of the complexity of the ecosystem. There are many players and while some are connected to multiple systems, many are not.
The above illustration also demonstrates that the DHHS is not well-connected to the various systems for the purposes of mental health treatment. While the DHHS has begun offering mental health outreach and connection to services within its clinical settings and homeless services, it does not receive funding from any mental health payor source (e.g., DMH, Medi-Cal Managed Care Organizations or Private Payors) for providing these services. 16 The mental health system for children (under 21 years) is just as complex. Mental health supportive services may begin as early as infancy and range in the levels of care depending on the child’s needs (see diagram below). School-aged children (5-18 years old) may be connected to on-campus services and supports or receive referrals to local agencies from their educators.
In Long Beach, service providers contracted through the DMH or Long Beach Unified School District (LBUSD) provide needed services to children who are Medi-Cal eligible. In addition, agencies can also contract with the LBUSD to provide services for children who have mental health conditions that interfere with the child’s educational attainment. To receive these services, the student needs an Individual Education Plan (IEP) that identifies their needs and connects them to contracted providers regardless of insurance. Children who are not Medi-Cal eligible, do not have an IEP, and do not have conditions that would warrant intensive outpatient services, must seek services through private insurance providers. This process can be lengthy and does not have a central entry point for families seeking services for their children.
Understanding the differences between agencies that are responsible for the care of different clients is a key factor since:
• Referring individuals to the appropriate system from the outset increases the timeliness of care and reduces frustration and potential drop-out.
• Maximizing the capacity of each mental health system limits default into systems not responsible for providing treatment.
17 Students enrolled in the local higher education system in Long Beach have access to on-campus supportive services. On-campus supports are not only limited in number but limited in the number of available sessions and this means long waiting lists. The recommendations the Advisory Group and consultants identified to enhance the children-serving mental health system align with those of the adult-serving system and, as such, ultimately work to improve access, build workforce capacity, enhance treatment, and invest in prevention.
Substance use disorder prevention and treatment services are planned and funded through Los Angeles County Substance Abuse Prevention and Control (SAPC) which is housed in the County’s Public Health Department. The SAPC contracts with local service providers within Long Beach.
Currently, SAPC records show 22 substance use disorder treatment and service providers in more than 50 locations both within the city and within a 10-mile radius. The online system no longer shows the total number of beds at each site, but it does show how many beds are available. At the time of this writing, the system showed that fewer than five residential beds and one residential detox bed were available. Bed availability can be seen on the Service and Bed Availability Tool (http://sapccis. ph.lacounty.gov/sbat/).
The Substance Use Disorder treatment system offers the following types of care.
Overall, within the system, there are service gaps, and not all levels of care are represented among the SUD providers. In addition, some providers provide levels of care only for specific populations (e.g., women and children, youth). Most SUD providers in Long Beach are funded by the SAPC. There are fewer private providers.
Substance Use Disorders
18 At an individual or family level, a person who has private insurance would not generally access services through the DMH as their insurance may provide coverage for a wide array of services; however, coverage levels may not cover the total cost of services. Individuals with Medi-Cal must work through their managed care
organization to access services
such as outpatient services and
medical care. However, if they need
more intensive treatment options,
they access treatment through
the DMH. The DMH contracts
with service providers across
the county, including providers
in Long Beach. For treatment of
substance use, individuals with
Medi-Cal must access services
through organizations funded
through the SAPC, which serves as
the managed care provider for all
Medi-Cal services for substance use
treatment. (Detailed information on
funding for different systems can be
found in Appendix A)
The DMH currently funds 21 providers across the continuum of services within Long Beach. There are also many service providers in Long Beach who take private insurance or Medi-Cal through the managed care system. In 2017, Star View Behavioral Health opened a DMH-funded Behavioral Health Urgent Care Center (BHUCC), which provides 24-hour access to mental health services in Long Beach.
In addition, at the higher levels of care for adults needing 24-hour residential programs, there are two DMH contracted Mental Health Rehabilitation Centers (MHRC) and one enriched residential service provider. There are no crisis residential treatment programs in the City. Based on a review of the DMH service locator, there is one DMH-contracted mental health/24-hour residential program in Long Beach serving youth. Many of these providers are at capacity, which means that the funded system is not meeting the needs of our children, adults, and people experiencing homelessness.
Mental health funding is nearly as complex as the system itself. California receives funds from the federal Substance Abuse & Mental Health Services Administration (SAMSHA), Center for Mental Health Services (CMHS) to provide mental health services to children with serious emotional disturbances and adults with serious mental health conditions. The state administers these funds and allocates them annually to the 58 county mental health plans. In addition, California voters passed the Mental Health Services Act (MHSA) in 2004, which is funded by a one percent income tax on personal income in excess of $1 million per year. The total estimated MHSA funds available at the State level for 2022-23 is approximately $1.4 billion. These funds are also distributed to counties for prevention and early intervention services, community services and supports, innovations, workforce education and training, and capital facilities and technology. In addition, the state provides general fund dollars to the Counties to provide services which also serves as a match to draw down federal dollars. LA County provides funding to DMH for specific initiatives such as homelessness and alternatives to incarceration. The DMH receives both federal and MHSA funding, which it allocates and manages through direct services, contracting out for services, and by making grants to support communities across the county, including the City of Long Beach.
How Mental Health and Substance Use Services are Funded 19 Focus Areas & Recommendations
For the remainder of this report, the DHHS has laid out focus areas and strategies within its scope of control and authority. Again, the DHHS and the City of Long Beach do not directly control funding for mental health and substance use systems. By State law, mental health and substance use system funds are distributed to counties, which are the jurisdictions for mental health and substance use disorder prevention and treatment. Establishing a more localized structure would require a shift in State policy and significant funding, including local City funding, to provide the infrastructure as well as the required local match for Medi-Cal services. Given the complexity of shifting policy and obtaining significant funding, the DHHS uplifts current practices and future efforts that lean on its role as a trusted leader in convening and coordinating stakeholders, with a strong focus on addressing disparities. The strategies and actions outlined below to strengthen and localize mental health services are feasible as funding and staffing resources are identified.
The recommendations are organized into four sections:
Each section consists of a short introduction in which the overall context, goals, and strategies, informed by the Mental Health Advisory Group and Capstone Solutions Consulting Group, are presented. The strategies are organized into three timeframes: accomplished, short-term, and long- term. Accomplished strategies are those that have been fully completed as of this writing. Short- term strategies are those that can be accomplished within the next eight to 12 months. Long-term strategies are those that can be accomplished within the next two to four years with adequate funding and capacity. It is assumed that intensively focused work to identify funding for these efforts will take place in both the short- and long term.
1. Mental Health Treatment Capacity
2. Prevention
3. Access to Treatment
4. Focus Populations
In Long Beach, all community members have an open path to access and receive the mental health support they need to thrive.
This report is grounded in the vision that the Mental Health Advisory Group established:
To fulfill this vision, providers across the community must increase prevention opportunities and access to services as well as the capacity for providing these services. The goals and strategies outlined below address these key areas.
20 Section 1: Mental Health
Treatment Capacity
Expansion of mental health capacity within existing infrastructure requires a sufficient workforce and funding to meet the need. Both are challenging and take time.
Increasing mental health treatment programs requires significant investment through funding of new programs or by reengineering existing programs. Launching new programs or expanding existing ones requires identifying State and local (county) funding opportunities, which often roll out at different times for different age groups or vulnerable populations. The high visibility of the need for mental health interventions has led to federal increases in state block grants for mental health and substance use treatment (including opioid addiction), the rollout of the 988 Crisis Line, California’s redesign of the Medi-Cal system under CalAIM, as well as increased funding opportunities being announced by Governor Newsom.
Organizations that want to add funding for Medi-Cal reimbursable services must apply for contracts through the DMH, the Los Angeles County Department of Public Health (DPH), or through managed care companies, which can take six months or longer and are generally awarded through competitive bid processes. Once contracts are granted, agencies must find space, attend to the administrative systems that will support new programs, and recruit and train staff. Contracting with County or State programs for the reimbursement of services involves lengthy processes for organizations interested in expansion. Once contracts are granted, expansion then relies upon the time it takes to recruit, hire, and train new staff to implement and administrate these programs. 21 In January 2023, Capstone Solutions Consulting Group administered a survey to the Mental Health Advisory Group members (see Attachment C). The survey captured organizational capacity and interest in delivering additional behavioral health services. More than 40 agencies that were engaged in the stakeholder process were invited to participate in the survey and 23 responded. Findings demonstrated that, in Long Beach:
• Providers have difficulty accessing information about new funding opportunities. • There is concern about infrastructure, including workforce availability and adequate workspace/ sites.
• It is difficult to develop and maintain a comprehensive system of care. • While many organizational representatives indicated that they are at capacity, some may have the ability to accept additional clients.
The inability to recruit and retain the necessary workforce stands as a formidable challenge to developing a robust local mental health system. More than half of the organizations responding to the survey administered by Capstone Solutions Consulting Group reported that workforce challenges have limited their ability to expand their services. In addition, in a recent report commissioned by the California Behavioral Health Directors Association (CBHDA) released in February 2023, an analysis of the workforce issue concluded that the shortage is due to several factors including non-competitive salaries, cumbersome paperwork requirements, and burnout.
Accomplished:
• The DHHS has prioritized building internal workforce capacity by investing recent State and federal workforce infrastructure funds in a new Workforce Officer position who, once hired, will lead staff recruitment, retention, and pipeline development efforts. Recruitment incentives will continue to be developed and offered for critical, hard-to-fill roles, including behavioral health positions.
• The DHHS has expanded mental health student practicum placements across its various clinical programs.
Short-Term Strategies:
• Work with the DMH and DPH to grow the eligible workforce by outlining ways to expand employment to individuals with lived experience to become community health workers, peers, promotoras, parent partners, and more.
• Encourage local mental health organizations to develop a budget for ongoing continuing education and professional development for staff as a best practice. • Partner with local universities to develop affordable professional development opportunities for local organizations.
• Track ongoing state initiatives to expand the mental health workforce and identify opportunities for Long Beach.
Build Workforce Capacity
Goal 1
22 Long-Term Strategies:
• Encourage the expansion of technology use by mental health service providers to enhance the scope and quality of services. Increase and improve training in new software to facilitate tele- mental health and other services.
• Update hiring practices and approaches to provide more employment opportunities for those with lived experience and focus recruitment on those from marginalized communities that experience poor mental health outcomes.
• Encourage organizations to establish benefit packages for employees that include student loan repayment or tuition reimbursement, similar to those offered by the nursing profession. • Create employment opportunities that allow for salary increases commensurate with professional growth.
• Partner with the LBUSD, Long Beach Community College, California State University Long Beach, and Workforce Development to develop and support educational and experiential pathways to behavioral health fields.
• Support further development of the workforce pipeline by helping train community mental health providers as preceptors, which allows for more placements from local university programs.
23 Ongoing, sustainable funding to support service coordination and access to prevention and treatment across the continuum of need is key to expanding options. Neither the DHHS nor the City of Long Beach receives a direct allocation of mental health funds; the City relies on DMH-funded services offered by community and faith-based organizations. Building a locally coordinated system requires that sustainable funding be identified for the DHHS. Additional funding to support local providers and new programs is also essential to building service capacity.
Accomplished:
• Received $1.35 million in grant funding from the Hilton Foundation to support a mobile mental health and substance use treatment program for people experiencing homelessness. These funds will also support a consultant to identify ongoing funding opportunities through CalAIM.
Short-Term Strategies:
• Provide information to existing service providers to help connect them with State and County mental health grant opportunities aligned both with the MHSA and the governor’s initiatives. • Partner with the LBUSD to expand school-based services through new funding opportunities such as the DMH’s Prevention and Early Intervention program and the California Children and Youth Behavioral Health Initiative.
• Explore opportunities for drawing down MHSA, Medi-Cal, and CalAIM funding to support direct service models within the DHHS, including becoming a licensed service provider for both CalAIM and Medi-Cal.
Long-Term Strategies:
• Pursue opportunities for direct mental health funding to come to the City to strengthen the collaborative infrastructure, enhance technology tools and expand existing programs such as the Community Crisis Response (CCR).
• Identify and support legislation to provide funding for the coordination of local mental health system efforts.
• Partner with the County to ensure that providers, especially those that are under-resourced, have sustainable and sufficient funding throughout the entire year so that services are not reduced at the end of funding cycles.
Increase Funding
Goal 2
24 Section 2: Prevention
Investment in prevention can reduce life-long impacts related to untreated mental health conditions.
In Long Beach, a significant number of individuals face mental health concerns and conditions which, in turn, affect their overall quality of life in many ways. In short, the prevalence of behavioral health conditions does not allow for a city and its residents to thrive. The COVID-19 pandemic has only exacerbated conditions for people already living with mental health diagnoses across the lifespan.
For those who are undiagnosed, the
constant uncertainty, trauma, and anxiety
that accompany mental health conditions
continue to impact their quality of life.
Unfortunately, the stigma around mental
health diagnoses and treatment still exists.
In some communities, the social norms
and stigma are so intertwined that mental
health conditions go untreated across the
lifespan. The strong connection between
mental health conditions and people
experiencing homelessness also acts as a
stigma. Mental health prevention efforts
are a critically important tool for building
community resiliency and preventing more
people from experiencing homelessness.
As outlined in a recent DMH presentation, prevention services are focused on reducing risk factors and other stressors that could lead to serious mental health conditions. The DMH does so by building protective factors such as social connections, concrete supports in times of need, knowledge of parent and child development, and social and emotional competence. DMH prevention resources focus on 1) individuals not currently receiving mental health services, 2) individuals or large groups of individuals who may be or are at risk, or 3) promoting preventative mental health services among priority subpopulations. Priority populations include individuals exposed to trauma, individuals experiencing the onset of serious psychiatric conditions, individuals experiencing extreme stressors, and underserved cultural populations.
25 Accomplished:
• Launched the city-wide “Mental
Health Matters” awareness
campaign designed to normalize
and destigmatize mental health
conditions and improve access and
connection to mental health supports
in Long Beach.
Short-Term Strategies:
• Identify programs in Long Beach
currently receiving DMH prevention
funding and work to leverage these
efforts in underserved communities
now experiencing significant
generational trauma and anxiety
because of structural racism, lack
of educational achievement and
economic success, and inadequate housing.
• Identify DMH prevention funding opportunities to support community-focused mental health prevention activities within the underserved communities described above. • Identify avenues to participate in the DMH Prevention Mental Health Promoters Network. • Support the expansion of Mental Health First Aid and other training programs for community members and community-based organizations.
Long-Term Strategies:
• Prioritize reducing community exposure to risk factors that lead to mental health conditions and increase opportunities for social and emotional well-being in communities with higher rates of poor mental health outcomes.
Increase Access to Mental Health Prevention in the City Goal 1
26 Section 3: Access to Treatment
The mental health system in California is comprised of many subsystems, including County-run specialty mental health and substance use services, managed care Medi-Cal services for individuals with less serious disorders, private managed care, and health insurance delivery systems. Access to these systems is based upon the individual or family’s benefits or insurance, the type of disorder, severity of their condition(s), age, and participation in other systems of care (e.g., child welfare system).
This complexity has created a network of systems that fails to meet the needs of the Long Beach community.
Increasing access to treatment depends in large part on increasing both providers’ and individuals’ overall knowledge of the mental health and substance use systems. Individuals need to be educated so they can understand admission criteria, determine their eligibility for services, and, most importantly, how to navigate the various service models. Providers and the systems they operate must be better coordinated to ensure effective referrals to appropriate services and, due to insufficient capacity in our city, particularly for intensive services, these systems must be coordinated at the regional level. According to conversations with local providers and clients, access to treatment services is difficult at all levels of care. In Long Beach, at the higher levels of care for adults needing 24-hour residential programs, there are two DMH contracted Mental Health Rehabilitation Centers (MHRC), and one enriched residential service provider. There are no crisis residential treatment programs.
Based on a review of the DMH service locator, there is one DMH-contracted mental health/24-hour residential program in Long Beach serving youth.
Accomplished:
• Updated the Mental Health Resource Guide on the DHHS website, which includes newly identified mental health agencies that are providing services in Long Beach. See Attachment B for the Resource Guide.
Increase Knowledge About the System
Goal 1
27 Accomplished:
• The DHHS convened the Mental Health Advisory Group to examine the local mental health system. This group will continue to meet to develop a local work plan to implement the strategies outlined in this report.
• Streamlined access to available mental health treatment opportunities in collaboration with the DMH. Providers are encouraged to contact the Service Area 8 navigators at (562) 256-7717 during business hours.
Short-Term Strategies:
• Establish a structure or mechanism for the DHHS to
serve as a coordinating body for a local behavioral health system of care, ensuring the DMH, SAPC, managed Medi-
Cal plans, and substance use disorder and mental health treatment providers are present and involved.
• Meet with representatives of the DMH Intensive Care
Division (ICD) to gain additional understanding of
residential treatment programs, and eligibility and
access.
• Share the resources for ombudsmen offices, established by the State, for individuals to report access-related
problems (currently exclusive to Medi-Cal funded
services).
Short-Term Strategies:
• Conduct training for providers and policymakers to educate them on the complexity of the mental health system and how they can best support their clients or constituents. • Create and update a repository of information and support tools so community-based organizations can stay current on mental health systems of care. • Develop culturally appropriate educational materials for clients and their family members so that they can better understand how to access care and support. • Develop system-wide training opportunities on generational trauma and trauma-informed best practices to inform client intake/assessment.
Long-Term Strategies:
• Continue to provide trauma-informed training opportunities for City departments and community partners.
• Continue to regularly update the Mental Health Resource Guide.
Simplify Access Through Coordinated Efforts
Goal 2
28 Long-Term Strategies:
• Encourage the simplification of enrollment processes among service providers locally and within the DMH to remove initial barriers to treatment. • Collaborate with managed care organizations to remove administrative barriers to common adult and pediatric referrals.
• Partner with existing service providers to streamline access by establishing a “no wrong door” local system for behavioral health care services.
• Establish a community-focused, language-accessible Mental Health Resource Hub to assist with referrals to care, determining benefits, and navigating resources. • Partner with the DMH to identify solutions for patient data sharing with the DHHS’s Homeless Services Division, Community Crisis Response Teams, and the Resource Line. • Explore information sharing through the existing Health Information Exchange (HIE) (see Attachment D for Information on Data Strategies). Participate in State planning efforts related to the rollout of the California Data Exchange Framework.
Accomplished:
• Through the Long Beach Recovery Act, the DHHS provided $300,000 in funding to contract with six Black Mental Health Providers to increase access to mental health care by connecting uninsured and underinsured Black residents to culturally affirming, quality mental health services at no cost.
• Identified a current listing of DMH Intensive
Care Division (ICD) programs, including
contact information for referrals, as well as
identified the website location where new
programs will be announced in 2023.
• Toured the MLK behavioral health campus
to understand service provision and
coordination of services across systems.
• Conducted a survey completed by 23 of the
organizations represented in the Mental
Health Advisory Group. The survey focused
on identifying existing capacity to treat more
clients and/or what would be required to
increase capacity (e.g., additional space,
staffing, funding). See Attachment C for a
summary of the results.
Increase Services
Goal 3
29 Outpatient Care
Crisis Response
Outpatient care focuses on services for less intensive mental health needs. It includes outpatient services, wellness centers, self-help and recovery services, case management, and crisis services, including the 988 Suicide and Crisis Lifeline, urgent care centers, and crisis mobile response teams.
The DMH launched a crisis response model in conjunction with its 988 Crisis Line. The DMH endeavors to identify crisis response provider organizations to support its efforts; however, existing capacity does not meet the City’s needs. To fill the gap the DHHS has planned, and will soon launch, a local Community Crisis Response (CCR) pilot program. Such a program was cited in the Racial Equity and Reconciliation Report (2020) as an important model that could be implemented in Long Beach. The CCR is a signature part of the City’s efforts to improve overall community health and safety through programs and services that meet residents’ needs through health-based approaches.
The CCR team will be dispatched directly to 911 calls to quickly provide the appropriate response to individuals and families experiencing behavioral health issues, or other non-emergency health or social welfare concerns, and to reduce unnecessary law enforcement or hospital-based interventions for non-emergency calls.
Short-Term Strategies:
• Look beyond the traditional service provider agencies to include faith-based organizations and non-denominational providers that offer counseling provided by mental health professionals. • Engage the DMH to determine the potential for a Clergy Academy in Long Beach. • Partner with City departments, community-based organizations, and faith-based organizations to allow for on-site mental health assessments and referrals. • Partner with service organizations to locate mental health providers in non-traditional settings such as libraries, park facilities, and other commonly used locations to expand access.
Long-Term Strategies:
• Expand mental health services to adults with depression and anxiety. Begin with convening meetings with representatives from managed care plans and their third-party mental health entities to explore options for expanding the non-specialty mental health network and ways to streamline access to existing network providers.
• Encourage employers to cover mental health care as part of their benefits package (for all employees).
• Investigate opportunities for the DHHS to become a mental health provider to support Community Crisis Response Teams and Homeless Services, as well as to integrate mental health services into other settings.
• Partner with the DMH to fund additional providers in the community, with a focus on providing culturally competent and culturally affirming care.
30 Intensive Care
A number of different service models fall within the category of Intensive Treatment Services including state hospitals, acute inpatient services for individuals in psychiatric crisis, long-term psychiatric care facilities, crisis residential treatment facilities, and enriched residential services. These are outlined in the table below. More specific program information can be found in Appendix G: Intensive Behavioral Health Services in Los Angeles. Information about the availability of intensive care programs for high-need individuals was not well known. Overall, issues that surfaced in stakeholder conversations highlighted the following:
• Admission criteria, referral, and placement processes for intensive care programs are not well understood.
• There are insufficient DMH Intensive Care Division (ICD) resources in Long Beach and the broader Service Area 8 (SA 8) for individuals with intensive care needs.
The CCR team can provide:
• Crisis intervention support
• De-escalation for individuals
• General health education
• Suicide assessment and intervention
• Items for basic needs (e.g., hygiene, clothing, nutrition supplements, et al.) • Triage to individuals requiring minimal medical aid (e.g., minor injuries including scrapes, cuts, and bruising with normal capillary refill)
• Transportation to appropriate resources such as the Long Beach Multi-Service Center, mental health urgent care, shelter, et al.
• Resource navigation and referral support for services The CCR team will consist of three field responders, including a Crisis Intervention Specialist (LCSW), a Public Health Nurse, and a Peer Navigator. This team will respond to calls Monday through Friday, from 10:00 am to 5:00 pm, within the jurisdiction of the West Long Beach Police Division.
Accomplished:
• The DHHS has hired and onboarded all staff on the CCR pilot and will launch in Spring 2023.
Short-Term Strategies:
• Build relationships with service providers in the community to refer CCR clients for ongoing support.
• Implement a data and evaluation strategy to evaluate the program and lead to continuous quality improvement.
Long-Term Strategies:
• Expand Long Beach’s Community Crisis Response Team by exploring additional funding opportunities at the County, State, and federal levels, including opportunities to collaborate with the DMH on mobile crisis outreach teams as part of the 988 Crisis Line rollout. • Expand response teams to 24/7 and city-wide operations. 31 Most intensive care services programs are located outside of Long Beach so individuals and families in need must travel to them.
The City seeks to increase access to sub-acute facilities, crisis residential treatment programs, and enriched residential services, as these services are very limited within Long Beach and the surrounding areas.
Short-Term Strategies:
• Engage with the DMH ICD and the Long Beach provider community to better understand intensive services, including, but not limited to, referral processes and admission and discharge criteria for each level of intensive care.
• Identify whether any mental health provider in Long Beach and surrounding areas has an interest in providing facilities such as a psychiatric health facility, enriched residential services or crisis residential treatment programs and encourage them to respond to/apply for DMH funding solicitations.
• Meet with representatives of the SAPC to gain additional understanding of residential treatment programs, and eligibility and access.
• Leverage SAPC expansion opportunities, particularly new funding for opioid addiction. • Convene meetings with providers interested in enhancing their programs and services by adding substance use treatment services for those with co-occurring disorders.
Long-Term Strategies:
• Identify locations within Long Beach that could serve as intensive treatment locations. Partner with the DMH to identify providers that may be interested in expansion and support providers’ abilities to utilize those spaces.
• Collaborate with the DMH ICD, Service Area 8, and community agencies to implement programs that serve individuals with intensive care needs, particularly crisis residential and enhanced residential treatment programs, as well as psychiatric health facilities in Long Beach. • Partner with the DMH to identify sustainable funding, streamline access, and coordinate services.
32 Section 4: Focus Populations
The DHHS recognizes that a number of diverse populations within our city are disproportionately impacted by mental health and substance use disorders and face additional barriers to services.
However, both existing service models and providers may not have the capacity to sufficiently address the unique needs presented. This section focuses on people experiencing homelessness and Transition Age Youth (TAY). The City’s recent proclamation of a homelessness emergency creates further urgency to allocate resources to expanding access to mental health services for people experiencing homelessness and transition-aged youth to support their success and prevent homelessness. In addition, the City acknowledges the need to identify additional resources for our other populations disproportionately impacted by mental health and substance use disorders.
The DMH has several programs that serve individuals and families who are experiencing homelessness and/or who are living with mental health conditions. Over the years, the Mental Health Services Act (MHSA) Community and Supports Plan (CSS) has allowed the DHHS to expand these services in an ongoing effort to address gaps
in services. Nonetheless, the service gaps
continue across the County, and it is reflected
in Long Beach. For example, there is only one
recuperative care provider and little access
to hospital step-down opportunities in Long
Beach.
During the 2022 Point-In-Time Homeless
Count, more than 1,200 people experiencing
homelessness indicated they had a severe
mental health condition, which represents
nearly 40 percent of the City’s homeless
population.
People Experiencing Homelessness
33 Steps the City is taking to increase access to mental health services for people experiencing homelessness include:
• Expanding mental health hours at the Multi-Service Center (MSC), including utilizing hours from mental health clinicians through the Black Health Equity Fund. • Increasing access to physical and mental health services for people experiencing unsheltered homelessness by expanding the REACH program to include an additional team. • Implementing a mobile therapy van that will have a mental health clinician and a SUD counselor to engage people at encampments, provide short-to medium-term therapy and allow people to access longer-term treatment services for mental health and/or substance use. • Increasing the availability of the LA County Department of Health Services (DHS) mobile medical clinic from once a month to twice a month. Work to ensure that the psychiatrist is available when the clinic comes to Long Beach.
• Hiring a part-time psychiatrist for the MSC who will also work in the field with individuals seeking access to medications in support of their mental health needs. • Working to access the DHS charting system (CHAMPS) to improve coordination as well as the ability to refer to specialized beds (such as recuperative care) located in surrounding cities. • Establishing low-barrier mental health programming for people experiencing homelessness at the MSC.
Short-Term Strategies:
• Pursue opportunities to support the addition of specialized beds for recuperative care and step-down following behavioral health hospitalization.
• Partner with the DHS and DMH to provide specialized staffing to support individuals with a wide range of both mental health and medical needs in shelter settings. • Partner with the DMH to reestablish the co-location of DMH staffing at the MSC.
Long-Term Strategies:
• Work with the DMH to create additional
full-service partnership (FSP) slots in Long
Beach to ensure that more people in need
of high-intensity outpatient mental health
services receive these services.
• Work to increase supportive housing units
that provide ongoing rental assistance
and supportive services to those with the
greatest needs.
• Increase the capacity of existing Board
and Care facilities to increase housing
retention.
• Work to increase intensive service locations, including crisis and enriched residential facilities, as well as recuperative care locations.
34 Transition-Age Youth are those from ages 16 - 24. As mentioned in the data section, there has been a dramatic increase in suicidal ideation among TAY youth, growing from 24 percent in 2020 to 30.5 percent in 2021 for youth in the State of California. In addition, data from the California Department of Health Care Access and Information shows that in 2020, 664 TAY in Long Beach visited the emergency room for a mental health condition. Those who identified as Black or African American had the highest rate of emergency room (ER) visitation due to mental health conditions. When compared to other races, the ER visitation rate for Black or African American youth was five times higher than that of Asian American and Pacific Islanders and about 1.5 times higher than that of White youth. The 2022 Homeless Point in Time data shows that youth, youth exiting the foster care system, students in higher education, and those who identify as LGBTQIA2S+ are falling into homelessness at disproportionate rates. Data shows that 21 percent of people experiencing homelessness were formally in foster care, 11 percent are LBGTQIA2S+, and 5 percent are students. Mental health prevention and treatment activities for youth are essential to homelessness prevention.
Transition-Age Youth (TAY)
Accomplishments:
• The DHHS submitted for a multi-year DMH Innovations project to support mental health prevention and intervention services for the TAY population. • The DHHS has secured a location and funding to open a 12-bed shelter for youth experiencing homelessness, which will include referrals to mental health services.
Short-Term Strategies:
• Further engage with the LBUSD, California State University Long Beach, and Long Beach City College to understand the gaps in services for students disproportionately impacted by mental health conditions and support the coordination of services to ensure students have access to mental health services.
Long-Term Strategies:
• Improve access to health, mental health, and trauma services by coordinating with the Long Beach Youth Services Network to engage health and mental health agencies, streamline referral processes, address policy and systemic barriers, and increase knowledge of available services with a focus on improving mental health outcomes for Black youth. 35 The DHHS has highlighted the many facets and complexities of the mental health system in this report. Given the urgency and local, regional, State, and national attention on this issue, the DHHS stands ready to tackle the next steps as funding and capacity become available. Together with our partners, allies, and community members, the DHHS is prepared to serve as a leader, coordinator, convener, and advocate for growing and expanding the local mental health system.
The DHHS expresses its gratitude to everyone who has contributed to this process so far and looks forward to working together to address this critical challenge.
Conclusion
36 Attachment A:
Capstone Solutions Consulting Group Presentation on the Behavioral Health System Serving Long Beach
37 38
39 40
41 42
43 44
45 46
47 48
49 Attachment B:
City of Long Beach Mental Health Resource Guide
50 51
52 53
54 55
56 57
58 Attachment C:
Summary Results of a Survey of Providers in Long Beach
In January 2023, Capstone Solutions Consulting Group administered a survey of current organizational capacity and interest in delivering additional behavioral health services. The survey was sent to more than 40 agencies that were engaged in the Mental Health Advisory Group stakeholder process; 23 responded. Key survey results and their implications are highlighted below.
Contracting
• Notably, none of the respondents have contracts with the County Department of Public Health for treatment of substance use disorders. This suggests that there is room for opportunity in the development of these services or the engagement of existing treatment providers. • Seven of the respondents – or 35% of the agencies – indicated that they have contracts with managed care companies for the delivery of behavioral health services. This information is generally not captured and could be beneficial when referring clients to services. It also suggests a possible growth opportunity for the additional responding organizations. 59 The services that exist throughout the age distribution for Long Beach are reflected above. Notably, 85 percent of agencies report serving adults over 60 years of age. There are a greater number of services for individuals in this age group than in other areas in Los Angeles County and it will be a strength as the population ages.
Waiting Lists and Capacity to Serve Additional Clients
Of 19 agencies answering this question:
• 6 reported having a waiting list (32%)
• 13 reported having no waiting list (68%)
It is important to note that this may be attributed to the practice of referring to other agencies in order to avoid carrying a waiting list.
When asked a similar question in a different way, providers were queried about whether they typically have a waiting list later in the fiscal year.
• 25% of agencies indicated that as funding ran short toward the end of the year, they typically have a waiting list
• 75% of agencies indicated that this does not typically occur.
Finally, when asked whether they could serve additional clients:
• 47% of agencies indicated they have the capacity to see additional clients • 53% of agencies indicated that they do not have the capacity to see additional clients Age Groups Served
60 Constraints related to growth
Twelve agencies indicated that they wanted to grow but encountered barriers. A summary of the reasons is as follows:
Given the recently released CBHDA report on behavioral health workforce issues, many of the staffing issues related to recruitment and retention are systemwide. There are some strategies that could be supported by the Long Beach DHHS:
• Support providers that do not currently have government contracts in pursuing this generally sustainable funding
• Offer opportunities to advertise job listings within Long Beach agencies • Identify sites at which providers might outstation staff In addition, many respondents indicated that they currently do, or would be interested in, hiring peers, family partners, and/or partnering with faith-based organizations. They would appreciate the support for these efforts from the DHHS, including training and mentoring. This would be an area in which collaboration with the local universities/schools of Social Work might benefit both the residents and organizations in Long Beach.
61 Attachment D:
Descriptions of Data Sharing Strategies
Efforts to modernize and transform data sharing are underway at the County, State, and federal levels.
In 2021, Governor Newsom signed AB133 into law which requires data sharing between entities within the health care and mental health systems by 2026. The bill also requires the California Health and Human Services Agency to establish a data exchange framework that includes a single data- sharing agreement and a common set of policies and procedures that will govern the exchange of health information in California. While various modernization efforts are underway, there are current practices that enable the sharing of client information for the purpose of coordinating care and improving patient outcomes.
The management of data is grounded by the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is intended to facilitate:
• Healthcare operations
• Health oversight
• Treatment
• Public health activities
HIPAA is one of several sets of regulations that govern information sharing about clients with mental health and substance abuse disorders.
Shared data systems:
A variety of technology systems exist at the County, State, and federal levels that optimize data coordination. Each mental health or substance use treatment agency engaged in data sharing would need to join selected systems on its own.
Health Information Exchange (HIE) describes the movement of data using technology platforms across different organizations in a region, referred to as a health information network (HIN). A Health Information Organization (HIO) facilitates the data exchange. These HIOs and HINs exist at various levels, continue to evolve, and have a range of functions. • Los Angeles Network for Enhanced Services (LANES) is the Los Angeles County HIE. Participants that have joined LANES to date include many of the large County Departments (e.g., Health Services, Mental Health), hospitals, and Federally Qualified Health Centers. Entry into LANES can be expensive and levels of access to client information vary.
Providers contracted with DMH or SAPC have direct access to the management information systems of these county agencies. Providers upload files of encounter information which are then visible in the system itself. While hospitals also enter this information, the timeliness of the data is variable. 62 Urgent access to treatment information:
Identifying and involving treating providers and determining prescribed medications is of critical importance when assessing and triaging individuals that may be suicidal. HIPAA permits the exchange of information in emergency situations. Both the DMH and SAPC maintain call centers that can be accessed 24/7. The call center numbers are (800) 854-7771 and (844) 804-7500 respectively. In the event either the DMH or SAPC is unwilling to share information under these circumstances, staff can facilitate contact with an agency of primary responsibility to share the need for direct intervention.
Sharing of information among treating professionals:
Several approaches have been used for the ongoing sharing of information among treating professionals:
• Certain electronic care coordination/care management options exist. For example, Netsmart introduced a care coordination/care management module for shared clients between providers at Tarzana Treatment Center and the San Fernando Valley Community Mental Health Center. The module enables both providers to view real-time information to assist in patient care. • Establishing a shared common consent form within collaborative programs has also proven to be successful. Programs like Children’s System of Care request that clients being served by the DMH, educational institutions, Probation, and the Department of Child and Family Services (DCFS) sign a shared revocable consent form to release information in order to coordinate care. 63 Attachment E:
Level of Care with Definitions
64 Attachment F:
List of Abbreviations
65 Attachment G:
Capstone Solutions Consulting Group Presentation:
Intensive Behavioral Health Services in Long Beach
66 67
68 69
70 71
72 73
74 75
76 77
Attachment H:
Mental Health Advisory Group Timeline of
Recommendations
ACTIONABLE SOLUTIONS – AREAS OF FOCUS
Timeline:
0-6 MONTHS (SHORT-TERM)
• Ease of Access
° Increase outreach to clients/community members. Utilize peer and parent partners. Hire and train community members to provide support and information through promotoras/ community health workers. (Currently being done at The Guidance Center and Disabled Resource Center)
• Workforce Development/Capacity
° Encourage the organization to hire professionals who have diversified expertise to offer space for consultation for colleagues or referrals within the organization. ° Provide more opportunities for those with life experience, which may include adjusting hiring practices. It is more organic than the school-to-work pipeline. • Funding
° Come up with policy changes that need to happen within the government to make funding more flexible.
° Provide technical assistance for those interested in applying for funding/grants. • Coordination
° Contract with experts that can provide technological, legal, ethical information regarding tele-mental health; offer training to agencies in Long Beach. ° Develop a decision tree for connecting individuals to services. • Data/Data Sharing
° Partner with Chance the Rapper’s organization to be the west coast city for their My State of Mind project. This will provide guidance for creating the community database. ° Go together as a Long Beach coalition to advocate for the interoperability of data solutions/ platforms.
78 6-12 MONTHS (MIDTERM)
• Ease of Access
° Revise assessments to capture information on trauma. Develop a system-wide training about generational/historic trauma.
• Workforce Development/Capacity
° Ongoing continuing education budget for staff (funding dependent). ° Partner with local universities and cover costs as a group. This will help address the issue with funding as the cost will be reduced.
• Coordination
° Create a resource directory with key contacts/numbers to expedite referrals or address concerns.
° Develop educational materials that provide information about eligibility and how to make referrals; offer training to staff.
° Explore information sharing used by Health Neighborhoods to provide feedback regarding referred clients.
° Identify a small pool of funding/way to get bus tokens to providers in order to support clients that have no transportation. (DMH clinics have/used to have bus tokens) • Data/Data Sharing
° Advocate for a reasonable/achievable mandate that all Mental Health providers contracted by county/City collect certain metrics so that we can have a common data set. ° Use research students from local graduate schools as interns for data analysis. 12-24 MONTHS (LONG-TERM)
• Ease of Access
° Develop more resources for crisis response that are fully staffed 24/7. Have more clinicians available for co-responses in order to reduce the presence of armed officers. ° Mobile mental health unit to increase outreach/access. OC has a van that does initial intakes and assessments, clinicians help coordinate transportation to services, a psychiatrist for med management, and a MediCal eligibility worker.
° Support with opening a crisis stabilization unit. College Medical Center is applying for emPATH to help triage community members.
• Workforce Development/Capacity
° Provide ongoing training to support the changing needs of clients coming into service (funding dependent).
12-24 MONTHS (LONG-TERM)
• Funding
° Provide free mental health support/care provided by employers and the government. • Coordination
° Collaborate with Managed Care to remove administrative barriers to common pediatric and/ or adult referral barriers (ABA therapy, Mental health). • Data/Data Sharing
° Learn from the build out of a real-time technology platform (through the county’s CCR work) and try to scale.
° Money to hire appropriately trained staff to look at internal data/trends in the local agencies who are serving.
79 Acknowledgements
Office of the Mayor
Rex Richardson, Mayor
Office of the City Manager
Thomas B. Modica, City Manager
Department of Health and Human Services
Kelly Colopy, Director
Dr. Jessica Schumer, Deputy Director
Erica Valencia-Adachi, Collective Impact Bureau Manager Christina Boatwright, MSW, Resource Connections Officer Stevie Luna Ibarra, MSW, Mental Health Coordinator
Hanna Stribling, MSW, Mental Health Coordinator
Laath Martin, Public Information Specialist
Mental Health Advisory Group
Ali Zandi PsyD, M.A., Director of Behavioral Health, TCC Family Health Andrea Utley, St. Mary/Common Spirit (Dignity Health)
Antonne Moore, Strategic and Network Development Chief, Los Angeles County Department of Public Health, Substance Abuse Prevention and Control
Ava Gillett, Ph.D., Community Medical Wellness Center
Broc Coward, COO, Downtown Long Beach Alliance
Christina Miller, Ph.D., President and CEO, Mental Health America of Los Angeles (MHALA) Deborah Miller-Calvert, Director of Health & Student Life, Long Beach City College Dolores Nason, Executive Director, Disabled Resources Center, Inc.
Donna Rosenlund, LCSW, Director, Social Work Services, Memorial Care, Long Beach Medical Center, and Miller Children’s & Women’s Hospital Long Beach
Elisa Nicholas, MD, MSPH, CEO, TCC Family Health
Gigi Zanganeh, MSW, Long Beach City Prosecutor’s Office Herlinda Chico, Senior Field Deputy, Office of LA County Supervisor Janice Hahn Joe Avelino, CEO, College Medical Center
Kimberly Wee, M.A., Vice President, Residential Services, Century Villages at Cabrillo Lisa Heemer, LCSW, Director of Clinical Services, Jewish Family and Children Services Lisa Honsberger, LCSW, Director of Community-Based Services, Jewish Family and Children Services Lori Willis, Ph.D., Service Area 8 Chief, Los Angeles County Department of Mental Health-SPA 8 Luther Richert, Chief Services Officer, South County, Mental Health America of Los Angeles (MHALA) Megan Owen-Heaton, St. Mary/Common Spirit (Dignity Health) Michele Winterstein, Ph.D., Executive Director, For the Child Patricia Costales, LCSW, CEO, The Guidance Center
Phil Wong, CEO, Gateways Hospital
Sandri Kramer, Suicide Prevention Program Director, Didi Hirsch Mental Health Services Scott Hanada, Service Area 8 Chief, Los Angeles County Department of Mental Health-SPA 8 Wendy Linderholm, PsyD, Director of Behavioral Health, Memorial Family Medicine Residency Program at MemorialCare
Consultants
Capstone Solutions Consulting Group
80 City of Long Beach
411 W. Ocean Blvd.
Long Beach, CA 90802
Long Beach Department of
Health & Human Services
2525 Grand Ave.
Long Beach, CA 90815
This information is available in an alternative format by request at 562.570.6257 For an electronic version of this document, visit our website at www.longbeach.gov/mentalhealth Visit us at www.longbeach.gov
facebook.com/LongBeachCity
LongBeachCity
Visit us at www.longbeach.gov/health
facebook.com/LBHealthDept
LBHealthDept