The Crisis and Recovery Enhancement (CARE) Technical Assistance (TA) Center works to strengthen criminal justice diversion efforts and the crisis care continuum to help all Californians access appropriate wraparound services and supports. The CARE TA Center provides training, TA, and resources to improve behavioral health care coordination for a flexible and seamless care delivery system. This newsletter provides information about CARE TA Center activities, resources, and no-cost learning opportunities; highlights the work of California’s 58 MHSA-funded Counties to elevate innovative and evidence-based practices; and reinforces a systemic approach to the crisis continuum of care and justice diversion across California. The views expressed in this newsletter do not necessarily reflect the California Department of Health Care Services or any other entity. 
In This Issue...

  • Strategies and Insights for AOT as an Opt-out Service: Takeaways from Interviewing DHCS’s Marlies Perez
  • AOT Recommendations and Insights from the Field
  • CARE’s AOT-Related Resource List and TA Requests
  • The California County Crisis Continuum Asset Map
  • New Resource Spotlight: New National African American Behavioral Health Center of Excellence
  • Upcoming No-Cost Trainings and Events
  • Recorded Webinars
  • Recorded Cafecitos
  • CARE TA Center Resource Library 
  • CARE TA Request Process
Get to Know Us!

The Crisis and Recovery Enhancement (CARE) Technical Assistance (TA) Center is a cross-agency team from the fields of mental health; training and technical assistance; crisis response and recovery; criminal justice diversion; and wraparound supports for youth and adults at greater risk of mental health crisis, including people experiencing homelessness.

The CARE TA Center is led by the Center for Applied Research Solutions (CARS) in partnership with RI International, NAMI California, C4 Innovations, Impact Justice, and Stanford Sierra Youth & Families. This project is funded by Proposition 63, the Mental Health Services Act (MHSA), and administered by the Department of Health Care Services (DHCS), Community Services Division.
Strategies and Insights for AOT as an Opt-out Service: Takeaways from Interviewing DHCS’ Marlies Perez


Assisted Outpatient Treatment, also referred to as “AOT” or “Laura’s Law,” was enacted in 2002 by California Assembly Bill 1421, and it refers to court-ordered outpatient treatment for individuals living with a severe mental illness. In counties that choose to adopt the program, AOT allows the county mental health director to petition the court to mandate treatment for individuals who have previously refused care and who meet strict eligibility requirements.

Since its introduction in 2002, AOT has functioned as an opt-in service. With the resolution of AB 1976, however, this will change: beginning July 1, 2021, counties will be required to offer AOT services or to pass a Board of Supervisor’s resolution to opt out (including justification for doing so). Counties who do not pass a resolution will be automatically opted into participation.

In anticipation of this transition, the CARE Team conducted a short interview with Marlies Perez, the Chief of the Community Services Division at the Department of Health Care Services (DHCS), which oversees the AOT Program. Perez shared her excitement about the passage of AB 1976, which “creates statewide access to behavioral health services and facilitates housing placement to a vulnerable population” (M. Perez, personal communication, January 20, 2021). She shared that “the expansion of the AOT program will necessitate an increased focus on homelessness and persons with serious mental illness.” As an opt-in program, AOT proved to be an effective program, and there are reasons to be optimistic that an increase in adoption among counties will correspond with an increase in healthy outcomes. As Perez pointed out, recent data “indicated improved independent living skills and social function amongst-court involved participants,” a trend that is likely to continue.

When asked what resources are available to support counties who are new to AOT, Perez highlighted the Behavioral Health Information Notice (BHIN) 20-075, as well as CARE’s resource library (discussed below). Additionally, Perez encouraged counties to reach out to the DHCS AOT inbox (DHCSAOT@dhcs.ca.gov) with specific questions or to schedule a technical assistance call. Perez also recommended that counties consider reaching out to established programs for additional learning. 

“It is imperative that counties assess the appropriateness and sustainability of the AOT program in their communities,” Perez stressed. The CARE Team, in collaboration with DHCS, is committed to supporting California counties as they start new AOT programs and continue to develop existing ones, and it will continue to highlight additional resources and strategies in upcoming newsletters and events.

The CARE Team expresses appreciation to Marlies Perez for her time and insight. Click here to read the full interview.
AOT Recommendations and Insights from the Field


With many counties participating in AOT for the first time this July (see immediately above), the CARE TA Center solicited experienced counties to develop lessons from the field. We are excited to share profiles of Nevada, San Francisco, and Los Angeles Counties.
 
Nevada County | Program Page
 
Which of the following best describes your county?
Completely rural (no urban areas)

Approximately how many people have been served by your county’s AOT program?
51 to 100
 
What year was your county’s AOT program established?
2008
 
What is the greatest benefit your county has seen from AOT?
Reduced incarcerations, hospitalizations, and acts of violence. Increased savings in money spent on mental health treatment, as well as increased engagement in mental health services.
 
What has been the greatest challenge to your county’s AOT implementation?
Initially getting people on board to its implementation—mainly attorneys and law enforcement.
 
What about your county’s AOT program are you most proud of or excited about?
The successes!
 
What advice do you have for counties who are preparing to implement AOT programs?
It is so important to get judge on board, first and foremost.

San Francisco County | Program Page

Which of the following best describes your county?
Mostly urban (densely populated cities and suburbs, at least 50,000 people)
 
Approximately how many people have been served by your county’s AOT program?
Over 100.
 
What year was your county’s AOT program established?
2015.
 
What is the greatest benefit your county has seen from AOT?
Significant reductions in psychiatric hospitalizations, crisis contacts, and incarcerations for those served. Increased engagement in ongoing services for participants.
 
What has been the greatest challenge to your county’s AOT implementation?
COVID has had a huge impact on our ability to successfully connect with individuals.
 
What about your county’s AOT program are you most proud of or excited about?
Having a robust multidisciplinary team, including integrating peers into our work and providing family support.
 
What advice do you have for counties who are preparing to implement AOT programs?
Take the time to develop the program, build relationships with stakeholders. Also, it is strongly recommended to have flexible funds to support engagement with clients.

Los Angeles County | Program Page

Which of the following best describes your county?
Mostly urban (densely populated cities and suburbs, at least 50,000 people).
 
Approximately how many people have been served by your county’s AOT program?
Over 100.
 
What year was your county’s AOT program established?
May 15, 2015.

What is the greatest benefit your county has seen from AOT?
Improved engagement with mental health services and a quarterly AOT oversight committee.
 
What has been the greatest challenge to your county’s AOT implementation?
Five two-person teams service all of LA County; there is limited staffing with distances from Kern County lines to Orange County lines.
 
 What about your county’s AOT program are you most proud of or excited about?
Staff is incredibly dedicated and hardworking, and is extremely effective at engaging clients. The majority of clients are voluntary and the staff’s ability to get them to engage into services is especially effective.
 
What advice do you have for counties who are preparing to implement AOT programs?
  • Develop a stakeholder process and form relationships with law enforcement and NAMI.
  • Involve judges and law enforcement from mental health court; get people to court from community and hospitalizations.
  • We don’t use police to get people to court; mostly we use WebEx now with the COVID-19 pandemic.
  • Getting compassionate assistance from law enforcement when you need it is key.
  • Meeting with the judge and reviewing cases before court with the public defender, county counsel, and mental health providers as a collaborative effort is extremely helpful.
CARE’s AOT-Related Resource List and TA Requests


The CARE TA Center is excited to partner with DHCS in supporting MHSA-funded California County Behavioral Health Departments stepping into AOT in July 2021. To this end, the CARE TA Center has developed an annotated list of AOT-related resources, all of which will be available in the CARE Resource Library, which now includes 30 AOT resources! These resources include implementation case studies; information related to funding opportunities and uses; efficacy studies, which highlight the positive impact of AOT; and much more.
Additionally, CARE welcomes AOT-related TA requests from the field (please submit requests on our webpage by clicking here). On Monday, April 12, 2021, CARE hosted a virtual panel presentation with 3 California Counties about their AOT programs. CARE would like to thank Los Angeles, Nevada, and Orange County for sharing their lessons learned and suggestions to the field for establishing AOT programs. A recording of this panel is available here and a closed captioned recording will be available on the CARE website in the next several weeks. These interviews and other helpful content will be shared on our social media pages, so please make sure to follow us.
The California County Crisis Continuum Asset Map


Last issue, the CARE TA Center announced a forthcoming tool, the California County Crisis Continuum Asset Map. This issue, we are excited to announce that the Asset Map is now live!
The asset map is an interactive dashboard that presents crisis continuum of care and justice diversion services in an intuitive and easy-to-use interface. The Asset Map draws on the publicly available information underpinning the MHSOAC Transparency Dashboard, which is then filtered through an algorithm before being uploaded to the dashboard. There, users can easily find services that support the crisis continuum of care and justice diversion, such as mobile crisis units, hotlines and warmlines, and peer specialist services—all of which are viewable by county.
New Resource Spotlight: New National African American Behavioral Health Center of Excellence (AABH-COE)

As the past year has demonstrated, many factors can affect human health and access to effective health services. This is no less true for behavioral health—mental health and substance-related conditions. Now a new source of training and information is available to help professionals and communities address health disparities and support the equity, effectiveness, and appropriateness of behavioral health services for African Americans.
Established by the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (DHHS, SAMHSA), the AABH-COE creates and provides training, written resources, and technical assistance to service providers in behavioral health and allied fields. The AABH-COE will work to name and understand these health disparities, as well as to prepare the field to correct them and address their effects. For more information about the AABH-COE, please click here.

The above resource description was taken from the AABH-COE press release, which can be read in full by clicking here 
Peer Specialist Workforce Professional Development Trainings
Trauma-Informed Care and Services

Dates: Monday April 19, 12:00-1:30 p.m. PT

This session will provide information on trauma, including the characteristics of traumatic events, the impact of trauma, and common evidence-based studies that emphasize the importance of trauma-informed care. We will provide tips on understanding and recognizing trauma and how to provide effective care for individuals with experiences of trauma.
 
HIPAA, Ethics, and Professional Boundaries

Dates: Friday, April 23, 12:00-1:30 p.m. PT

This session will cover the general code of ethics for mental health professionals, HIPAA rights, and the importance of medical records and mandated reporting. We will discuss in depth of the general professional ethics and boundaries as well as provide information of the laws for protection of both the professionals and clients.
 
Self-Care and Compassion Fatigue

Dates: Monday, April 26, 12:00-1:30 p.m. PT

This session will cover the general code of ethics for mental health professionals, HIPAA rights, and the importance of medical records and mandated reporting. We will discuss in depth of the general professional ethics and boundaries as well as provide information of the laws for protection of both the professionals and clients.
 
Presenters:
Ragini Lal is a dedicated, compassionate, solution-driven mental health advocate and humanitarian for underserved populations. She is currently the Community Engagement Manager at NAMI California, with experience in qualitative and quantitative research, cultural competency and responsiveness trainings, family and peer support trainings, report writing, and executing mental health equity and advocacy through large events. She received a Bachelor’s in Psychology at California State University, Sacramento, and is currently pursuing a Master’s in Mental Health Clinical Counseling - Marriage, Family, and Children program to obtain a License in Professional Clinical Counseling (LPC- CA). Ragini is certified in Mental Health First Aid for Youth and Adults, Psychological First Aid, Cultural and Linguistic Competence Certification, and Peer & Family Support Specialist. Formerly a Behavior Health Therapist at Genesis Behavior Center and Peer Counselor at California State University, Sacramento, Ragini has direct clinical experience with diverse communities, families, and children with various mental health conditions. Ragini was also a Crisis Peer Counselor at California Coalition for Youth, specifically working with peer youth and family members in need of immediate crisis counseling. Her long-term goal is to earn a PhD in Clinical Psychology, specializing in holistic healing to provide whole health care for diverse populations world-wide. Her work’s devotion is to empower others to believe in their personal strengths in an all-inclusive clinical healing journey—moreover, to increase systemic changes for more sustainable access to care through education and social advocacy.
Angela Brand is the Vice President of Strategic Engagement at NAMI California. She has extensive experience in mental health programming focused on community engagement, advocacy, and training, having worked in both public and private sectors with consumers and family members. Prior to joining NAMI California, she worked for the Mental Health Services Oversight and Accountability Commission and United Advocates for Children and Families.

She is passionate about peer- and family-led system transformation and the inclusion of individuals in all aspects and levels of decision making. Her areas of special interest include advocacy, family and peer support, youth mental health and leadership development, prevention, early intervention, and education. Her work is driven by a passion to develop systems that improve access to care through community-based and recovery-focused programs that are reflective of and responsive to the needs of diverse populations. Ms. Brand holds a degree in Sociology from Arizona State University.
More New Events
Mobile Crisis Outreach Teams: Staffing and Policies

Dates: Thursday, April 22, 2:30-4:00 p.m. PT

Join us for a three-session series about mobile crisis outreach teams (MCOT) with CARE TA Center partner RI International. Building on the first presentation, Mobile Crisis Units 101—which provided an overview of MCOT and which can be accessed by clicking here—this second presentation will explore the ways to operationalize MCOT services. Audiences will learn the staffing models, training needs, and infrastructure necessary to deploy Mobile Crisis Outreach Teams utilizing SAMSHA’s National Guidelines for Behavioral Health Crisis Care.

 
Did you miss Session 1? Watch it now!
In the first session of the MCOT series, Jamie Sellar reviewed multiple crisis response models used in the U.S., with a deeper dive into the model endorsed by SAMHSA. Jamie also covered the importance of a street-level response to crisis care that diverts away from uniformed law enforcement officers as the caregiver of last resort.

Presenter:
Jamie Sellar, MA, LPC, is a behavioral health executive with 25 years of successful experience in running crisis programs in multiple states. These programs have included both inpatient, sub-acute, residential, mobile crisis outreach teams, hospital rapid response, and mental health urgent care centers. Currently, Jamie specializes in crisis system development and operational management. In his current role as Chief Strategy Officer at RI International, he consults both nationally and internationally on topics such as crisis system optimization, peer use in the workforce and program design. Jamie has a long history of training professionals and paraprofessionals on practical client engagement strategies. A licensed clinician, Jamie strongly believes that the rapport between caregivers and those in need is a primary driver of success in crisis work. RI (https://riinternational.com), is a global organization with more than 50 behavioral health programs throughout the United States and abroad, provides Crisis, Health, Recovery and Consulting services, wherein our values and priorities include: maintaining a recovery culture, ensuring clinical best practices, making safety a priority for all, measuring value and results, optimizing quality and compliance, and serving as a key resource for First Responders.
Film Screening: "The S Word"

Dates: Tuesday, April 27, 1-3 p.m. PT

Join us for a screening of the documentary “The S Word,” a SAMHSA Voice Award-winning film that breaks the silence and undermines the shame of suicide. The critically acclaimed “The S Word” is filmed by a suicide survivor who interviews a diverse group of people across race, ethnicity, gender, and sexual orientation about their experiences of trauma, suicide, survival, and mental health advocacy. Following the film screening, participants will receive multimedia socially distanced suicide prevention resources, from warm and crisis lines to self-help mental health apps and virtual support groups.
 
Presenter:
Heliana Ramirez, PhD, LISW, is a licensed clinical social worker with over 20 years of experience. Dr. Ramirez has addressed a variety of clinical issues through individual and group interventions, including suicide prevention and postvention, Veteran post-deployment health, psychosocial rehabilitation, LGBTQ minority stress and resilience, trauma-informed care with combat Veterans and survivors of sexual assault, HIV/AIDS and Hepatitis C prevention, and substance abuse harm reduction efforts. Dr. Ramirez’s suicide prevention work with clients includes suicide assessments, developing Safety Plans, crisis intervention, and assessing the continuum of crisis care systems. Dr. Ramirez organized the nation’s first multi-state LGBT Veteran Suicide Prevention Conference and produced a documentary about trauma and recovery among LGBT Veterans that addresses suicide from a strengths-based and culturally-specific perspective (www.camouflagecloset.com).
Save the Date: CARE’S Crisis Continuum of Care and Justice Diversion Conference

Dates: Wednesday, June 16 and June 17, 2021

The CARE Team is excited to announce that it will be hosting a virtual conference on June 16 and June 17. Stay tuned for more information about this multi-day event!
Recorded Webinars

Did you know that you can access all of our recorded webinars for on-demand learning through the CARE website? If you missed Jamie Sellar’s recent overview of Mobile Crisis Outreach Teams (MCOT) in crisis care systems, you can now watch it—and other webinars—at your convenience!
Recorded Cafecitos

The CARE TA Center is excited to share a new, short form of content! These eight-to-25 minute recordings capture informal conversations about pressing topics in the crisis continuum of care and justice diversion. The Cafecito recordings will be shared on our social media channels and websites; the first recording—a conversation about mobile crisis units with RI International’s Wayne Lindstrom, PhD—is now available! 
The Resource Library is growing! Here’s the link for you to check it out yourself:
https://care-mhsa.org/resources/. The Resource Library aims to help you find resources and tools to advance your behavioral health care coordination, criminal justice diversion, and crisis care continuum efforts. If you have created a resource that you would like considered for inclusion in the CARE TA Resource Library, please submit it here.
TA REQUEST PROCESS

We are happy to announce that we are officially accepting Training and Technical Assistance requests from the field! CARE TA Center team members and subject-matter experts provide trainings and direct 1:1 consultation on a variety of topics related to strengthening behavioral health care coordination, criminal justice diversion efforts, and the crisis care continuum. Submit your request now and we’ll get back to you within four business days. Here’s the link: https://care-mhsa.org/training/.
We look forward to connecting with you and bringing you fresh new updates in our next quarterly newsletter!
CARE TA CENTER PARTNERS
Want to learn more about the CARE TA Center partners? Click on one of the links below:

Stay in touch with us through social media!
 
Contact the Crisis and Recovery Enhancement TA Center
 
Toll-Free: (888)-550-6155  Email: caremhsainfo@cars-rp.org