Winter 2021 CARE Quarterly Newsletter

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...

Get to Know Us: Our CARE TA Center Staff and Partners
We Want to Hear from You: California County Corner
California County Corner: Highlighting Promising Practices
Peer Certification – DHCS Funding Stream Update
Laura’s Law: 2018-2019 Report Overview
MHSOAC Transparency Suite: Finding Services in your Area
Upcoming No-Cost Trainings
Recorded Webinars
New Resource Spotlight
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.

California County Corner: Highlighting Promising Practices

Across California’s 58 MHSA-funded county programs, tremendous work is being done on the crisis continuum of care and justice diversion. There is great diversity in the availability, implementation, and evaluation of crisis care continuum services like mobile crisis units, employment of peer specialists, and engagement of people who are experiencing homelessness into mental health services. The CARE TA Center would like to showcase innovative processes, practices, and systems within and across California’s counties. If you would like your work to be considered for inclusion in the CARE TA Center Newsletter’s California County Corner, please email the CARE TA Center Project Manager [email protected].

Peer Certification - DHCS Funding Stream Update

In the previous issue of this newsletter we discussed the momentous signing of SB 803, which allows California to join 48 other states with Peer Certification standards of training, scopes of practice, supervision, and billing procedures. More recently, DHCS has released a Behavioral Health Information Notice (BHIN) that provides “funding guidance for counties to initiate or expand their peer programs using existing fund streams” during this early period of SB 803.

The BHIN contains detailed documentation for funding streams related to peer support specialists. Funding streams discussed include:

California’s Medicaid Program (Specialty Mental Health Services, Drug Medi-Cal Organized Delivery System)
The Community Mental Health Services Block Grant
Mental Health Services Act
Office of Statewide Health Planning and Development
Substance Abuse Prevention and Treatment Block Grant

Click here to access the full BHIN and learn more about funding stream uses, limitations, and reporting requirements. For additional information, please visit DHCS’ Peer Support Services webpage. This page will serve as a central hub for SB 803 peer support services implementation activities, including a point of contact, resources, stakeholder feedback opportunities, an implementation timeline, and other helpful information.

Laura's Law: 2018-2019 Report Overview

Contrary to common stereotypes, the majority of people with mental health challenges are not violent; in fact, they are more likely to be victims of violence than perpetrators of it (Stuart, 2003). Research suggests that when violence does occur among people living with mental illness, the violent behavior is more strongly associated with exposure to violence (in one’s neighborhood and childhood); substance use; social factors (like gender and age); and personal-life stressors, such as homelessness than mental illness (Fazel et al., 2009 and 2010; Siever, 2008; Volavka et al., 2010). Across the nation, states are employing the intervention of Assisted Outpatient Treatment (AOT) as a prevention intervention for the minority of people living with mental illness who have a history of violence and court involvement, through coordinated justice diversion efforts and community-based, multi-disciplinary behavioral health care (McCance-Katz, 2020 and Cripps, 2018).

Known as Laura’s Law, California’s Assisted Outpatient Treatment Demonstration Project Act of 2002 provides “court-ordered community treatment for individuals with a history of hospitalization and contact with law enforcement” (DHCS, 2020; p. 5).[1] The goal of AOT is to reduce client homelessness, psychiatric hospitalization, and engagement with law enforcement. AOT outcomes are reported annually by the Department of Health Care Services (DHCS). The 2018-2019 DHCS report “Laura’s Law: Assisted Outpatient Treatment Demonstration Project Act of 2002” describes AOT as an invaluable resource for individuals identified by a medical professional as “unlikely to survive in the community without supervision” (p. 15).

The DHCS 2018-2019 AOT report describes outcomes from a total of 19 participating counties, with 13 counties serving one or more people experiencing mental health challenges and court involvement. In total, 914 individuals were served, with 686 people voluntarily entering the program and the remaining 228 people participating via court order or settlement. AOT successes are considerable for the 228 court-involved individuals who experienced reductions in homelessness (30%), psychiatric hospitalizations (33%), and contact with law enforcement (43%). DHCS concludes that the “AOT and program support are contributing factors in helping clients avoid or reduce hospitalization, homelessness, and incarceration” (p. 4). The CARE TA Center celebrates the 19 counties whose AOT programs documented considerable safety outcomes of reduced violent behavior (64%) and victimization (85%) among court-involved participants, as well as reduced substance use (34%) among participants with co-occurring mental health and substance use challenges. From a trauma-informed perspective, the value of reduced violent behavior from and victimization toward AOT participants cannot be overstated when discussing their mental health and the safety of their neighbors, their family, and the state of California.

Please note that in July 2021, counties will be required to opt out rather than opt in to AOT (i.e., county participation in AOT will be required without a state-issued waiver of exemption). For more information, please email [email protected]. As your county prepares for AOT participation, stay tuned for an upcoming CARE TA Center distance learning opportunity to hear lessons learned from counties experienced in AOT. For information about AOT, access a training by the National Association of Mental Illness (NAMI) here.

[1] For a full description of AOT eligibility, see Appendix B of Laura’s Law: Assisted Outpatient Treatment Demonstration Project Act of 2002.

References

California Department of Health Care Services, Community Services Division. (2020). “Laura’s Law: Assisted Outpatient Treatment Demonstration Project Act of 2002. For the Reporting Period May 2018 – April 2019”. Retrieved on 12/30/20 from Laura's Law (ca.gov).

Cripps, S.N., Swartz, M.S. (2018). Update on Assisted Outpatient Treatment. Current Psychiatry Reports 20, 112. Retrieved on 12/30/20 from https://doi.org/10.1007/s11920-018-0982-z

Fazel S, et al. (2010). "Bipolar Disorder and Violent Crime: New Evidence from Population-Based Longitudinal Studies and Systematic Review," Archives of General Psychiatry: Vol. 67, No. 9, pp. 931–38.

Fazel S, et al. (2009). "Schizophrenia, Substance Abuse, and Violent Crime," Journal of the American Medical Association: Vol. 301, No. 19, pp. 2016–23.

McCance-Katz, E. F. (2020). SAMHSA: creating a system of care that meets the needs of people with mental and substance use disorders. Psychiatric Services, 71(5), 416-418.

Siever LJ. (2008). "Neurobiology of Aggression and Violence," American Journal of Psychiatry: Vol. 165, No. 4, pp. 429–42.

Stuart H. (2003). Violence and mental illness: an overview. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 2(2), 121–124.

Volavka J, et al. (2010). "Violent Behavior in Mental Illness: The Role of Substance Abuse," Journal of the American Medical Association: Vol. 304, No. 5, pp. 563–64.

MHSAOC Transparency Suite: Finding Services in Your Area

Did you know that you can use the Mental Health Services Oversight & Accountability Commission (MHSOAC) Transparency Suite to find county-specific services for supporting individuals in an emergency health crisis? Many of the services listed help connect individuals in need with mental health services and professionals who can provide culturally informed support to individuals accessing services at different stages of the crisis care continuum.

The CARE Team is in the process of developing an asset map that will provide optimized filtering to better meet your needs. In the meantime, you can visit the MHSOAC Transparency Suite by clicking here. The Transparency Suite includes an array of services that address the entire crisis care continuum. In total, the Suite contains 2,438 programs. Among these, there are at least:

375 services that provide or support justice diversion
34 services across 21 counties that provide mobile crisis response
190 services that provide culturally responsive support
210 services throughout the state that support behavioral health recovery

Note: Counts based on 2018-2019 data. This analysis is still in progress, and we use “at least” to suggest that these totals are not intended to be conclusive.

Tomorrow! Mobile Crisis Units Webinar

Date: 1/15/21, 10:30 a.m.-12:00 p.m. PT

This webinar will be a review of the role of Mobile Crisis Outreach Teams (MCOT) in crisis care systems. It will include a review of multiple models being used throughout the United States, with a deeper dive into the model endorsed by SAMSHA’s National Behavioral Health Crisis Care Guidelines. There will be an opportunity to ask questions, get clarification, and learn the importance of a street-level response to crisis care that diverts away from uniformed law enforcement officers as the caregiver of last resort.

The intended audience for this presentation includes behavioral health administrators, emergency response workers, and front-line behavioral health workers, including social workers, psychologists, and peer specialists. Click here to register.

Trainer: 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.

Mental Health Needs Following Rapid Release from Jails and Prisons with COVID-19 Outbreaks

Date: 2/17/21, 2:30-4:00 p.m. PT

The CARE TA Center provides training and technical assistance regarding the crisis continuum of care and justice diversion in California. With the rapid release of people following high rates of COVID-19 in incarcerated facilities, mental health needs and gaps in service are amplified by reduced mental health services due to social distancing, the recession, and elevated COVID-19 rates in communities of color and low-income communities. This webinar will provide real-time insight into the emerging needs across the state and highlight challenges and opportunities to improve the system of crisis continuum of care and justice diversion.

Trainer: Terah Lawyer finds purpose in working to improve the justice system. She is the program manager for the Homecoming Project, an innovative re-entry housing program at Impact Justice. Her role includes matching eligible participants to compatible hosts while securing a support network for each arrangement. Being formerly incarcerated, Terah has been an advocate for incarcerated people for more than a decade as a peer health educator, a certified drug and alcohol counselor, and a youth diversion specialist. She is a past chair of the Beyond Incarceration Panel with the Central California Women’s Facility. She also developed numerous curricula for therapeutic workshops and groups that empower and change the lives of people in California’s state prisons. Terah is a musician, graphic designer, and public speaker. She serves as a spokeswoman for the Drop the Life Without the Possibility of Parole campaign. She was featured on “A Living Chance” and “Wanda’s Picks” podcasts. Terah has also been at the forefront of restorative justice efforts, both inside prison and beyond. She interned at American Friends Service Committee’s Healing Justice Project, volunteers with the California Coalition for Women’s Prisoners, and is a Next Generation Fellow at Center of Juvenile and Criminal Justice and the National Institution for Criminal Justice Reform. She joins Impact Justice with undergraduate degrees in business management and social & behavioral science. Terah is a Bay Area native.

Recorded Webinars

Did you know that you can access all of our recorded webinars for on-demand learning through the CARE website? Recent presentations include:

Seeking Safety, presented by Gloria B. Osborne, LCSW

Skills Training: Suicide Prevention Safety Planning, presented by Dr. Heliana Ramirez

Self-help and the 2020 Holidays: Managing Stress During the Winter Season in Pandemic Times, presented by Dr. Heliana Ramirez

Crisis Services: Meeting Needs, Saving Lives

A comprehensive and integrated crisis network is the first line of defense in preventing tragedies of public and patient safety, civil rights, extraordinary and unacceptable loss of lives, and the waste of resources. There is a better way. Effective crisis care that saves lives and dollars requires a systemic approach. This new resource from SAMHSA delineates how to estimate the crisis system resource needs of a community, the number of individuals who can be served within the system, the cost of crisis services, the workforce demands of implementing crisis care, and the community-changing impact of best-practice services. “Crisis Services” includes SAMHSA’s “National Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit” as well as other articles on topics such as rural services, youth crisis care, and law enforcement collaboration.

ACCESS RESOURCE >

Striving for Zero: California's Strategic Plan for Suicide Prevention 2020-2025 Mental Health Services Oversight and Accountability Commission (MHSOAC)

Striving toward no lives lost to suicide will require a dedicated and sustained effort to integrate practices known to prevent suicide into our education, justice, healthcare, and other systems and our communities. This comprehensive strategy incorporates the latest information and evidence to guide state and local actions for the benefit of all Californians and to save lives. This document outlines public health recommendations and strategies to prevent suicide that are aligned with national calls for advancements in innovation and health care access. It includes detailed discussion of four strategic aims and how to achieve them: suicidal behavior in California; suicide risk and protective factors; and universal, targeted, and intensive best practices.

ACCESS RESOURCE >

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 send it to Program Manager Tiara Peterkin, LCSW, at [email protected].

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.