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Alpine County Behavioral Health Department Mental Health Service Act Innovation Component Three-Year Program & Expenditure Plan Fiscal Year 2013-2016 POSTED May 10, 2013 – June 10, 2013 This MHSA Innovation Plan was made available for public review and comment May 10,2013 through June 10, 2013. Public Hearing Information: Board of Supervisor’s Meeting Room 99 Water Street, Markleeville, CA 96120 Monday, June 10, 12:30 pm – 2:00 pm Hosted by Alpine County Mental Health Board Questions or comments? Please Contact: Alpine County Behavioral Health 74-C Diamond Valley Road Markleeville, CA 96120 Phone [PHONE REDACTED]; Fax: [PHONE REDACTED] Thank You! ---PAGE BREAK--- Acknowledgements Alpine County Behavioral Health Department wishes to thank the many agencies, family members, and county residents who helped guide the development of the planning process and the creation of the Innovation Plan: Alpine County Board of Supervisors Alpine Native TANF Alpine County First 5 Choices for Children Alpine County Mental Health Board Dial-A-Ride Alpine County Unified School District and Office of Education Learning Center Alpine Health and Human Services Hung-A-Lel-Ti Community Alpine Kids Woodfords Indian Education Center The preparers of this plan are particularly appreciative of the commitment and guidance provided by the MHSA Planning Committee, comprised of Chris Stewart, Clinical Coordinator, and Amy Broadhurst, MHSA Program Specialist. MHSA Innovation Project Team: Roberta Chambers, PsyD, Resource Development Associates Mei-Li Hennen, PhD, Resource Development Associates Linda Hua, MA, Resource Development Associates ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 3 Table of Contents Acknowledgements 2 EXHIBIT A 4 EXHIBIT B 5 EXHIBIT C 11 EXHIBIT C.1 14 EXHIBIT C.2 19 EXHIBIT C.3 20 EXHIBIT C.4 21 EXHIBIT C.5 24 EXHIBIT D 25 EXHIBIT E 26 EXHIBIT F 27 Appendix A 30 Appendix B 31 Appendix C 33 Appendix D 35 ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 4 EXHIBIT A INNOVATION WORKPLAN COUNTY CERTIFICATION County Name: Alpine Director of Behavioral Health Name: Nichole Williamson Telephone Number: [PHONE REDACTED] ext. 230 Email: [EMAIL REDACTED] MHSA Program Specialist Name: Amy Broadhurst Telephone Number: [PHONE REDACTED] ext. 3 Email: [EMAIL REDACTED] Mailing address: P.O. Box 387 99 Water Street Markleeville, CA 96120 I hereby certify that I am the official responsible party for the administration of public community mental health services in and for said County and that the County has complied with all pertinent regulations, laws and statutes for this Innovation Work Plan. Mental Health Services Act funds are and will be used in compliance with Welfare and Institutions Code Section 5891 and Title 9, California Code of Regulations (CCR), Section 3410, Non-Supplant. This Work Plan has been developed with the participation of stakeholders, in accordance with Title 9, CCR Sections 3300, 3310(d) and 3315(a). The draft Work Plan was circulated for 30 days to stakeholders for review and comment and a public hearing was held by the local mental health board or commission. All input has been considered with adjustments made, as appropriate. Any Work Plan requiring participation from individuals has been designed for voluntary participation therefore all participation by individuals in the proposed Work Plan is voluntary, pursuant to Title 9, CCR, Section 3400 All documents in the attached Work Plan are true and correct. Signature (Local Mental Health Director/Designee) Date Title ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 5 EXHIBIT B INNOVATION WORK PLAN Description of Community Program Planning and Local Review Processes County Name: Alpine County Work Plan Name: Integrated Family Wellness Center Instructions: Utilizing the following format please provide a brief description of the Community Program Planning and Local Review Processes that were conducted as part of this Annual Update. 1. Briefly describe the Community Program Planning Process for development of the Innovation Work Plan. It shall include the methods for obtaining stakeholder input. (suggested length – one-half page). 2. Identify the stakeholder entities involved in the Community Planning Process. 3. List the dates of the 30-day stakeholder review and public hearing. Attach substantive comments received during the stakeholder review and public hearing and responses to those comments. Indicate if none received. Alpine County’s MHSA Steering Committee is led by Chris Stewart, Clinical Coordinator, and Amy Broadhurst, MHSA Program Specialist. The MHSA Steering Committee’s role is to monitor all MHSA programs to ensure that the county is following MHSA state guidelines. The MHSA Steering Committee also collaborates with stakeholders and members of the community to develop MHSA plans and updates. For the purposes of the MHSA Innovation plan work session, stakeholder groups included mental health and public health providers, Board of Supervisors, Mental Health Board, child welfare, childcare agencies, schools, family members, and consumers of mental health services. In 2013, Alpine County Behavioral Health Department (ACBHD) embarked on a planning process for the Innovation component of the Mental Health Services Act (MHSA). The Planning Team was comprised of the MHSA Steering Committee and Resource Development Associates (RDA), a consulting firm with established mental health planning expertise. The team utilized a participatory framework to encourage community buy-in, while leveraging information and resources across other MHSA components in concurrent stages of development or implementation (Community Supports and Services and Prevention and Early Intervention). Garnering information across several components of MHSA allowed for a deeper, more comprehensive understanding of community and service needs, and the development of a more refined community vision for behavioral health systems change. ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 6 Key Innovation Community Planning activities included: Key Informant Interviews: To understand community needs and challenges, six key informant interviews were conducted with foster parents, and members representing the Mental Health Board, Alpine Unified School District, Alpine Native TANF, and the Learning Center. Outreach and Engagement: The MHSA Committee contacted county members through mail, email, phone, and flyers, and presented work session details at county meetings (see Appendix A for posted MHSA Innovation Planning announcement). MHSA Plan Work Session: The MHSA Community Work Session consisted of four planning activities: o MHSA Program Overview – A presentation was conducted to review each MHSA component and components active in Alpine. This informed each stakeholder about MHSA principles and features of the Innovation component. o Brainstorming Activity – Brainstorming occurred in small groups to determine underserved populations and identify service needs. o Prioritization Activity – Once the small groups identified underserved populations and service needs, stakeholders presented their findings to the larger group. In the large group, stakeholders were asked to prioritize the top population group and service needs. Outputs from this exercise provided the groundwork for the Innovation plan. o Approval Process - The MHSA Steering Committee reviewed the prioritization feedback and approved the Innovation priority. During the month of February 2013, the MHSA Steering Committee identified key informants to include family members, foster parents, as well as representatives from the Mental Health Board, Alpine Unified School District, Alpine Native TANF, and the Learning Center. Six key informants were asked questions to determine ways the county could increase access to services and access to underserved groups, improve quality services, and promote interagency communication. All key informants identified Native and non- Native children ages 0-5 as underserved groups. Service needs were also unanimous in that key informants identified children and family service supports as priorities. ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 7 To encourage stakeholder participation in the Innovation plan work session scheduled February 26, 2013, community outreach was conducted via mail, email, phone, flyers (see Appendix announced at county meetings by the MHSA Steering Committee, and by word-of-mouth. Twenty-four community members participated in the Innovation planning process. The table captures the diversity of participants’ gender, ethnicity, age, and relationship to the service system. Information in the table reflects only those who completed a demographic information form. Those in attendance were representative of the diverse community of stakeholders. During the work session, stakeholders were informed of the MHSA components and requirements, brought up to date on current and planned MHSA work within the County, and engaged in a highly- interactive and collaborative brainstorming session. Stakeholders were divided into four brainstorming groups to identify underserved groups and service needs to construct a framework for the Innovation plan (see Appendix In small groups, stakeholders were asked five key questions: Who are the underserved population? What group do you believe is not accessing mental health services? What are the unmet mental health needs? What are the barriers to accessing services? What would it look like if programs served the underserved population and mental health needs were met? What do you want to learn from these new programs? What main program goals will be met? The stakeholders then reconvened as a large group and prioritized their top three program ideas for the Innovation plan: First Priority – Stakeholders identified geographically-isolated families with children ages 0-5 as the most underserved population in the county. The key barrier that stakeholders identified for this population was the lack of transportation. Stakeholders reported that they wanted to have a centralized location for family services with transportation. Stakeholders also wanted a resource specialist to be the liaison between behavioral health and social services to build an integrated system of care. When asked what they wanted to learn from this program, stakeholders reported that they wanted to learn how and Total Innovation Participation Based on total meeting sign-ins 24 sign-ins; 16 demographic forms submitted 1 consumer of mental health services 1 family member of a consumer 4 consumers and family members 3 older adults (60+) 4 females, 12 males 7 Caucasian/White, 1 Hispanic/Latino, 1 Asian, 7 Native Americans ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 8 to what extent families would receive appropriate services based on need. Another learning objective they wanted to see was how and to what extent services would decrease substance abuse, mental health issues, and determine whether families accessed appropriate medical care. Second Priority – The second most underserved population identified by stakeholders was parent education supports among parents with children ages 0-5. Stakeholders expressed concerns about the lack of child services for children under 4 years old. More specifically, stakeholders reported that there was a lack of parent education skills building classes, and no universal screening tools. Stakeholders voiced that parents in the community were uncertain how to identify developmental issues with their children and how to respond to developmental delays and other early childhood needs. Similar to the first priority, stakeholders reported that there was not a centralized space where families could learn skills from one another that fostered trust and engagement. Programming for this population would include parent workshops, weekly universal screening and assessments, observation classrooms, and parenting classes. The purpose of this priority was to educate parents how to catch early signs of developmental or behavioral issues that enabled children to live healthy lives. The learning objective identified by stakeholders was to understand how and to what extent parents could increase their child development and parenting skills knowledge to meet the needs of their small children. Third Priority – Stakeholders identified special needs children ages 0-3 as an underserved population. As such, parents with special needs children lacked the education, skills, and supports to offer adequate parenting. Stakeholders suggested that the program have family support groups, parent education classes, and universal screening and assessments. Stakeholders suggested that the learning objective, much like the previous two priorities, would be to understand how and to what extent parents would receive the education and skills to support special needs children. It is evident that the county stakeholders were committed to families with young children. This included geographically-isolated families as well as Native and non-Native families. Having centralized services for families in a neutral space that fosters a safe place for the community was a key priority among stakeholders. The MHSA Steering Committee reviewed each priority area expressed by the stakeholders and included many of the ideas that are central in this plan. The 30-day public comment period opened on May 10, 2013 and closed June 10, 2013. A public hearing was held on June 10, 2013, during which stakeholders were engaged to provide feedback about the innovation plan. Fourteen stakeholders attended the public hearing, representing consumers, family members, the Washoe tribe, ACBHD staff and clinicians, Alpine County Board of Supervisors, Alpine County personnel, and Alpine County Office of Education. ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 9 Based on feedback from stakeholders during the public hearing, the following revisions were made to the plan: Revisions were made to the name of the Early Learning Center to “Learning Center” as the Early Learning Center was named for the now-defunct preschool. Program information was updated for Live Violence Free. Program information was updated for Markleeville Library Story Time and Bookmobile Services. Program information was updated for Washoe Healing Center. The following concerns were raised during the public hearing: Worried about children aging out of the Integrated Family Wellness Center during the three years of implementation—if a child receiving services turns six years old, what happens to that child? o Response: Families with children will not be turned away from this program. Program participants will also have access to PEI and other available services. o Change: The plan was modified to revise the target population from families with “children 0-5” to “families with young children.” Follow-up: I want to see this plan succeed. We should have a lawyer come in once a month, a NAMI advocate once a week, someone from the Board of Supervisors come in weekly so that we can ask them questions. Let’s open this place up, have people come in and let’s do this right. o Response: As the program starts, we can look at what the needs and wants are and continue to add to the services available for the target population. I want to make sure that we advocate for elders. We should have some kind of program for children 0-5 to interact with elders and the Integrated Family Wellness Center. I feel that elders are left out of County things. Maybe we can set a pilot program that is beyond the 50+ Club and arrange for all people who are 50+ to come to the program. o Response: Let’s add the needs of seniors to the annual update process and discussion. o Response: A senior wellness center is proposed in the annual update. I hoped we could get a bus out of this innovation plan. How do we get children to the Integrated Family Wellness Center to access programs and services? How will screenings take place? o Response: The program can provide transportation for families to participate. o Screening process was also explained. This plan is great, it’s good, it’s beautiful. What we’re doing is a beautiful thing here. Will the programs each have an office space at the Learning Center? o Response: They have an option to schedule space, but they won’t each have their own office on site. They can use the collaborative room. In the evaluation timeline, we should move “secure space” to 2014. o Change: The task “secure space” was moved to 2014. We should make it clear that this is experimental! So people will not expect services to be permanent. ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 10 o Response: The program will need to do outreach and educate the community about available services and what Innovation is. ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 11 EXHIBIT C Innovation Work Plan Narrative Date: April 30, 2013 County: Alpine Work Plan 1 Work Plan Name: Integrated Family Wellness Center Purpose of Proposed Innovation Project (check all that apply) X INCREASE ACCESS TO UNDERSERVED GROUPS INCREASE THE QUALITY OF SERVICES, INCLUDING BETTER OUTCOMES X PROMOTE INTERAGENCY COLLABORATION X INCREASE ACCESS TO SERVICES Briefly explain the reason for selecting the above purpose(s). Alpine County, California lies along the crest of central Sierra Nevada, south of Lake Tahoe and north of Yosemite. Alpine County is rural and the smallest California County with a population of 1,175 (US Census Bureau, 2010). Most of the population is concentrated around a few mountain communities: Markleeville, Woodfords, Bear Valley, and Kirkwood. Markleeville is the County seat and home to many of the county’s offices. County departments and agencies provide direct services, and Alpine County has no incorporated cities. Alpine County is a “Small County” which is defined as a California county with a population of less than 200,000 as determined by the most recent census data. Population in Alpine County is comprised of 65.6% White, 19.9% American Indian/Alaskan Native, 7.0% Hispanic or Latino, 3.3% Asian, 2.4% with two or more non-Hispanic races, and 1.8% Native Hawaiian/Pacific Islander.1 Partially situated in Alpine County, the Federally-recognized Washoe Tribe of Nevada and California includes four communities, with three in Nevada and one in Alpine County. The Washoe community in Alpine is concentrated in the town of Woodfords. 1 U.S. Census Bureau, 2007-2011 American Community Survey ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 12 Of the 1,175 residents in Alpine County, 15.2% lives below the poverty level, and 10.1% of the population is unemployed2. As such, many families with children under five and those families living in geographically-isolated areas are at greater risk of behavioral health problems. This is due to limited access to basic medical and behavioral health services. In the Native American community, the poverty rate is 37.6%, which is twice as high as the general population in Alpine County, and the Native American community has a higher unemployment rate of 12.2%3. As such, Alpine County plans to use MHSA Innovation funds to increase access and family services for this population. As mentioned previously, Native families represent 19.9% of Alpine County’s population. Although this number is high, Native families are underrepresented in Alpine County’s behavioral health system. The Washoe Tribe of Northern California and Nevada became a federally recognized tribe in 1937, and the tribe established the Washoe Tribal Council in 1966. In 1996, the Washoe Tribe, including the Hung-A- Lel-Ti Community within Alpine County, was approved for reassumption of exclusive jurisdiction, and is the only California Indian tribe authorized under the Indian Child Welfare Act (ICWA) to exercise exclusive jurisdiction over child welfare matters involving the Tribe’s children residing on the Tribe’s reservation lands4. Once the Washoe Tribe obtained exclusive jurisdiction, more than 10 children were transferred from jurisdiction of the Alpine Superior Court to the Washoe Tribal Court. Since that time, the Alpine County Child Welfare Services responds to Washoe child emergencies only and provides information to Washoe Tribal Social Services5. This history has resulted in Washoe children and families accessing mental health, and many other County-provided children’s services, less than non-Native families. To increase service accessibility to Native residents, Alpine MHSA PEI developed the Hung-A- Lel-Ti Wellness Center located on tribal land. While the Wellness Center has increased engagement for adults and seniors, it has not resulted in significant engagement for children and families. The innovation project aims to increase service access to geographically-isolated families and Native and non-Native families with young children. Alpine County will employ an integrated service delivery model that is centrally located to reach the underserved groups. 2 U.S. Census Data 2011: http://quickfacts.census.gov/qfd/states/06/06003.html 3 Ibid. 4 California Courts. The Judicial Branch of California. Washoe Tribal Courts. Website. Retrieved on March 25, 2013 from http://www.courts.ca.gov/14798.htm 5 An excerpt from the Alpine County Health and Human Services letter to the Board of Supervisors re: Exclusive Jurisdiction and the ACHHS System of Improvement Plan requesting a MOU with the Washoe Tribe (approved by the BOS on December 7, 2010). Retrieved on March 25, 2013 from http://alpineca.granicus.com/MetaViewer.php?meta_id=35286&view=&showpdf=1 ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 13 Alpine County Superintendent of Schools Office of Education opened the Learning Center in 2004. The center provides early care and education to children ages eight weeks to five years old. The Learning Center is in a centralized location, offering an array of family services. The Learning Center is considered a neutral space for all families, and is currently accessed by both Native and non-Native families. The existing partners at the Learning Center include Alpine Unified School District, Alpine First 5, Choices for Children, Live Violence Free, and Tahoe Youth and Family Services. Alpine County’s objective is to bridge services between providers and families using established tools and techniques at a location that is both familiar and safe. Through the use of existing partners located at the Learning Center and new services such as Public Health Nursing, Native Wellness Advocacy, Washoe Healing Center, the Washoe TANF program, Parent Child Interactive Therapy (PCIT) and transportation services, Alpine County aims to integrate services in one location so underserved families can receive comprehensive treatment and support. Alpine County intends to co-locate the Integrated Family Wellness Center at the Learning Center. With centralized services, the project will promote interagency collaboration and increase access to services that target geopraphically-isolated families, and Native and non-Native families with young children. ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 14 EXHIBIT C.1 Project Description Describe the Innovation, the issue it addresses and the expected outcome, i.e. how the Innovation project may create positive change. Include a statement of how the Innovation project supports and is consistent with the General Standards identified in the MHSA and Title 9, CCR, section 3320. (suggested length - one page) The proposed innovation aims to increase service access to families, specifically Native and non-Native families with young children and geographically-isolated families. The innovation project offers collaborative behavioral health care and social services co-located at the Learning Center. The Learning Center currently offers early care and education to children ages eight weeks to five years old. The innovation project referred to as the Integrated Family Wellness Center aims to build upon an established interdisciplinary team who offer expertise in children and family service delivery. Innovation service offerings include: Choices for Children Family Mental Health Services First 5 services Live Violence Free Markleeville Library Story Time and Bookmobile Services Native Wellness Advocacy Supports Parent Child Interaction Therapy (PCIT) Public Health Nursing Universal Early Screening and Assessments Washoe Healing Center Washoe Language Program Washoe TANF Program ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 15 Programs and Services Choices for Children is a service provider currently located at the Learning Center. This provider will conduct parent education, offer hands-on learning for children, and provide a toy lending library for families who need toys for their children. In addition, this provider will also offer childcare resources and linkages to all families accessing the Integrated Family Wellness Center. The Tahoe Youth and Family Services agency will provide family reunification services, family counseling, work with pregnant mothers who struggle with substance abuse, crisis counseling, and offer a 24-hour crisis line. Mentoring services are offered to children ages four and above. Mentors are adults from the community who have been screened and trained. Mentors will take children to movies, the playground, parks, and facilitate other activities that support healthy child development. Alpine County First 5 is a service currently located at the Learning Center. First 5 will provide parenting skills and conduct in-home visits to families with children ages 0-5 who access the Integrated Family Wellness Center. First 5 is also a family resource agency and will provide family support linkages. Live Violence Free is the only provider of domestic violence and sexual assault services in Alpine County. Live Violence Free offers a variety of programs and services related to helping victims, survivors, and their children through the healing process. These programs and services include advocacy and accompaniment, peer support, free legal advice and representation, individual therapy, Nurturing Parenting Program home visits, a 24-hour hotline and basic needs. The Markleeville Library offers story time events which offers families an opportunity to interaction among themselves and with other families in a setting centered on young children. Additionally, the Markleeville Library has a Bookmobile which serves as a library on wheels. The Learning Center will be incorporated into the library’s story time calendar and scheduled Bookmobile stops. ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 16 Appropriate staffing is needed to catch early signs of developmental issues and needs. The purpose is to have happy healthy children, in a thriving community. - Stakeholder A Native Wellness Advocate will offer weekly services at the Integrated Family Wellness Center. The advocate can offer cultural competency training to staff and offer resources to Washoe families. Parent Child Interaction Therapy (PCIT) is a behavioral family intervention for children 2-7 years of age with disruptive behaviors. It has been identified as a best practice and integrates concepts from social learning theory, traditional play therapy, and attachment theory to enhance the parent-child relationship, increase children’s pro-social behaviors, and increase parents’ behavior management skills. The program is implemented in two phases. The first phase is the Child Directed Interaction phase during which parents develop child-centered interaction skills. The second phase is the Parent-Directed Interaction phase during which effective discipline skills are the focus. PCIT gives equal attention to the development of the parent-child relationship and the development of parents’ behavior management skills. A critical goal of PCIT is to increase positive, nurturing interactions. PCIT will play an integral part to help Alpine County parents develop child centered interaction skills and effective discipline skills. Alpine County’s Health and Human Services will provide public health nursing services at the Integrated Family Wellness Center. Additionally, the nurse will conduct in-home visits, provide early screenings, and offer prenatal and perinatal care education. The Integrated Family Wellness Center will provide early screening and assessments to identify and respond to developmental delays and other early childhood needs. Examples of possible screening tools includes the Child and Adolescent Needs and (CANS) comprehensive assessment, Ages and Stages Questionnaire (ASQ-3), Child Development Inventories (CDI), and others. The County will use a PCIT clinician or public health nurse to administer universal screening tools. This approach will offer a continuum of care not otherwise in place. The Washoe Healing Center will partner with the Integrated Family Wellness Center. Services include evaluation and treatment for Washoe children who are victims of abuse. This agency will offer specialized counseling for children, individuals, and families. Services also include substance abuse counseling and referrals. Washoe Healing Center services are open to non-Native individuals as well. The Washoe Language Program will partner with the Integrated Family Wellness Center. Services include language classes through the Washoe Tribe to promote interaction between families of different ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 17 cultures. The classes would allow families to share their languages and cultures, promoting greater integration across the historic divide. A representative from the Washoe TANF Program will offer services at the Integrated Family Wellness Center. Services will include cash assistance and supportive services to eligible needy Native families with children in need of temporary aid and services. The TANF program may provide parents, or caretaker relatives who are participants with job preparation, employment opportunities, and supportive services to increase self-sufficiency. The TANF representative can offer services in the Washoe native language to ensure engagement and cultural competency. MHSA General Standards This proposed program model is consistent with the General Standards identified in the MHSA, and emphasizes age-specific needs, community collaboration, consumer and family participation and involvement, cultural competence, programs and services, and wellness, recovery, and resilience. This program is based upon community input regarding the need for alternative service approaches for families offered in a community-based setting central to both Native and non-Native families. The program is built upon collaboration between ACBHD, community based organizations, and other stakeholders. The Integrated Family Wellness Center aims to increase the level of participation and involvement of underserved families with young children. To increase family participation and involvement, Alpine County aims to approach service delivery through which each family participates in the development of a family plan. This family plan is determined through family-identified goals, and needs. By co-locating the program at the Learning Center, a non-clinical space known to be neutral ground among Native and non-Native families, the proposed innovation will help eliminate disparities in accessibility and availability. Program services will integrate both Native and Non-native traditions and approaches that are responsive to culture, race, ethnicity, gender, orientation, and religious/spiritual beliefs. Additionally, this program will adopt a broad definition of family, recognizing that extended family and “chosen” family members may be included in family services and supports, as requested by the parent and/or family. ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 18 With centralized services co-located at the Learning Center, the innovation project will promote interagency collaboration and an integrated service delivery environment that targets geopraphically- isolated families as well as Native and non-Native families with children ages 0-5, not otherwise available. With the co-location of services, this will provide opportunities for formal interdisciplinary planning and informal opportunities for collaboration amongst providers involved with the same family and/or community. This program increases resiliency and promotes recovery and overall wellness for Native and non-Native families. The program is designed to strengthen the ability of Native and non-Native families to foster their child’s wellbeing and health. The Integrated Family Wellness Center will be offered and provided to all families without requiring that they engage in any other ACBHD services. Specifically, services may be accessed without having to engage in any traditional or consultations or treatments. Only those families who present with significant needs, or who express interest in receiving adjunctive services will be referred for additional assessment. ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 19 EXHIBIT C.2 Contribution to Learning Describe how the Innovation project is expected to contribute to learning, including whether it introduces new mental health practices/approaches, changes existing ones, or introduces new applications or practices/approaches that have been successful in non- mental health contexts. (suggested length - one page) Alpine County’s Integrated Family Wellness Center project contributes to learning through modified practices and approaches that have been adapted to increase access to services for geographically- isolated families as well as Native and non-Native families with young children. Rather than providing separate service sites for the Native and non-Native families, as many other counties have done, Alpine’s approach is to provide culturally-competent services while leveraging a centralized location that families currently access due to the connection with the school district. Further, because the Learning Center is managed through the school district, the operations and atmosphere are familiar and safe for all families. The location is also considered neutral territory among native and non-native county residents. The anticipated outcome of this approach is to increase access and utilize interagency services in one location for underserved and geographically isolated families with young children. As such, this approach leverages the use of existing agencies already onsite at the Learning Center and adapts a number of existing practices for the unique issues facing Alpine County. The anticipated outcome in leveraging these existing resources is to increase access to services for rural families with young children by providing multiple services at a co-located site. For instance, while parents are attending workshops, their children may receive a developmental screening. The interagency collaboration enabled by this approach aims to increase wellbeing among participating children and families. More specifically, the Integrated Family Wellness Center project aims to answer the following research questions: How and to what extent did the program recruit and train culturally-competent service delivery staff? How and to what extent did the program promote interagency collaboration? How and to what extent did the program improve the overall health and wellbeing of the children and families accessing services? How and to what extent did the program increase parenting skills to support their children’s health and wellness? How and to what extent did the program identify and respond to developmental delays and other early childhood needs? ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 20 EXHIBIT C.3 Innovation Project TimeLine Outline the timeframe within which the Innovation project will operate, including communicating results and lessons learned. Explain how the proposed timeframe will allow sufficient time for learning and will provide the opportunity to assess the feasibility of replication. (suggested length - one page) Alpine County’s three-year Innovation project timeline outlines the proposed schedule of operational activities from start -up through the final year of MHSA Innovation funding in 2016. The timeline includes the steps to implement the Integrated Family Wellness Center, hire and train staff, recruit participants, and promote interagency collaboration. The timeline incorporates interim program evaluations to engage stakeholder feedback, and make program improvements. To launch the implementation, ACBHD will establish an integrated wellness family center advisory board to help design, implement, and monitor the program. To ensure the Innovation project is in alignment with the innovation program objectives, Alpine County will employ an evaluation process to measure and evaluate progress and areas for improvement. See Table 1 below: Table 1. Implementation & Completion Dates Activities 2013 2014 2015 2016 Planning and Development Hold Public Hearing & Finalize Plan Secure space at Learning Center Convene MHSA Planning Committee Recruit, hire, & train staff Conduct outreach and engagement activities Implementation Develop an Integrated Family Wellness Advisory Board Begin service delivery Service Delivery Make program adjustments Conclude project Make program adjustments Measure & Evaluate Select Evaluator & Develop Evaluation Design Collect and analyze Data Interim/Annual Report Collect and analyze Data Interim/Annual Report Annual Update/Final report ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 21 EXHIBIT C.4 Project Measurement Describe how the project will be assessed and reviewed and how the County will include the perspectives of stakeholders in the review and assessment. Alpine County proposes to design and implement an Integrated Family Wellness Center to serve all families in Alpine County, with the specific aim of increasing access to services for geographically- isolated families and Native and non-Native families with young children while promoting interagency collaboration utilizing behavioral health and social services co-located at the Learning Center. The learning objectives created from the work plan session will drive the project evaluation process (see Exhibit C.2). The evaluation will also incorporate the three purpose areas determined by the MHSA Innovation component guidelines: Increase access to underserved groups. Promote interagency collaboration. Increase access to services. The Innovation program evaluation will measure the quality and impact of services of geographically- isolated families and Native and non-Native families with young children who access the Integrated Family Wellness Center. The areas for evaluation are in two categories: Program learning objectives and service learning objectives. The program evaluation will determine to what extent the project met MHSA’s purpose areas. The service evaluation will determine to what extent the project services improved the overall health and wellbeing of geographically-isolated families and Native and non-Native families with young children. The program evaluation aims to assess how and to what extent the Integrated Family Wellness Center was able to: 1. Increase access to services for geographically-isolated families and Native and Non-Native families with children age 0-5. 2. Recruit and train culturally competent service providers. 3. Promote interagency collaboration. The service evaluation aims to assess how and to what extent the Integrated Family Wellness Center was able to: 4. Improve the overall health and wellbeing of children and families accessing services. ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 22 5. Increase parenting skills to support their children’s health and wellness. 6. Identify and respond to developmental delays and other early childhood needs. 1. To assess how and to what extent the program was able to increase access to services for geographically-isolated families and Native and Non-Native families with young children, the project will record all outreach and engagement efforts relative to families contacted. The project will also collect demographic and retention data of participants enrolled, compare family participation rates to historical data, and continue to monitor participation on an interim and annual basis. 2. To assess how and to what extent the program was able to recruit and train culturally- competent service providers, the project will record recruitment, hiring, and training methods for all participating service providers. Additionally, the project will also conduct consumer perception surveys to assess participants’ perceptions of how the levels of care and cultural competence were exercised by service providers. 3. To assess how and to what extent the program was able to promote interagency collaboration, the project will record the number of referrals and linkages made to and from the Integrated Family Wellness Center. Additionally, the project will also conduct consumer perception surveys to assess participants’ perceptions of how convenient it was to engage in multiple services through the Learning Center. 4. To assess how and to what extent the program was able to improve the overall health and wellbeing of children and families accessing services, the project will collect pre- and post- service data related to participants’ health and wellbeing. Case notes and other relevant documentation may be used. 5. To assess how and to what extent the program was able to increase parenting skills to support their children’s health and wellness, the project will collect pre- and post-service data related to participants’ parenting skills, health, and wellbeing. Pre and post testing for training may also be used to compliment assessment findings. 6. To assess how and to what extent the program was able to identify and respond to developmental delays and other early childhood needs, the project will record the results of screenings and the results of referrals to address identified needs and delays. The early intervention practices and policies set in place in the program will be reviewed and record rates at which they are used. Additionally, pre-service data from universal early screening tools will be collected from all participants who may or may not have developmental needs. Post-service data of participants who were identified as having developmental needs will also be collected. This approach will evaluate the services delivered. ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 23 The integrated family wellness advisory board will be involved in the design of the service delivery model, the project’s evaluation methodology, and implementation plan. This group will be directly involved in reviewing all project evaluation outcomes. Results of interim evaluation reports will be presented to the advisory board for feedback and problem solving. These reports will also be distributed to Alpine’s Local Mental Health Board and the Alpine County Board of Supervisors. Interim reports will also be posted on the ACBHD website, at the Learning Center, the Wellness Center, and other community sites as determined by advisory board. Open community meetings to generate feedback and recommendations may be conducted by the advisory board as needed. This process will provide opportunities for stakeholders and members of the community to offer input at the program, consumer, family, staff, and community levels. ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 24 EXHIBIT C.5 Leveraging Resources (if applicable) Provide a list of resources expected to be leveraged, if applicable. As previously mentioned, the Integrated Family Wellness Center’s strategic location will allow the program to leverage existing agencies co-located at the Learning Center. Additionally, the Learning Center is supported by and connected to other agencies. Agencies listed below include: Alpine County Behavioral Health Alpine County First 5 Alpine County Health and Human Services Alpine County MHSA Native Wellness Center Alpine County Unified School District Choices for Children Live Violence Free Markleeville Library Tahoe Youth and Family Services Washoe Healing Center Washoe Language Program Washoe TANF Program ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 25 EXHIBIT D Innovation Work Plan Description (For Posting on MHSAOAC\\storageio\RDA_SHARED_DRIVE\Current_Projects\Friends_Outside\BJA_Second- Chance-Mentoring\FINAL Website) County Name: Alpine County Behavioral Health Department Work Plan Name: Integrated Family Wellness Center Annual Number of Clients to be Served: 40 Native and non-Native families with young children and geographically isolated families. Provide a concise overall description of the proposed Innovation (suggested length - one-half page). The proposed innovation aims to increase service access to families in Alpine County, specifically targeting Native and non-Native families with children ages 0-5 and geographically-isolated families. The innovation project offers collaborative behavioral health care and social services co-located at the Learning Center. The Learning Center currently offers early care and education to children ages eight weeks to five years old. The innovation project referred to as the Integrated Family Wellness Center aims to build upon an established interdisciplinary team who offer expertise in children and family service delivery. Innovation service offerings include: Choices for Children Tahoe Youth and Family Services First 5 services Live Violence Free Native Wellness Advocacy Supports Parent Child Interaction Therapy (PCIT) Public Health Nursing Universal Early Screening and assessments Washoe Healing Center Washoe TANF Program Services ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 26 EXHIBIT E Innovation Funding Request (FY 2012/13 – 2013/14) Mental Health Services Act Innovation Funding Request County: Alpine County Behavioral Health Department Date: April 29, 2013 Innovation Work Plans Required MHSA Funding Estimated Funds by Age Group (if applicable) No. Name Children, Youth, Families Transition Age Youth Adult Older Adult 1 Integrated Family Wellness Center $232,600.00 x 2 3 4 5 6 7 8 9 10 Subtotal: Work Plans $232,600.00 $ $ $ $ 11 Plus County Administration 12 Plus Optional 10% Operating Reserve 13 Total MHSA Funds Required for Innovation $232,600.00 ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 27 EXHIBIT F Innovation Projected Revenues and Expenditures (2013-2014) County: Alpine 2013-2014 Work Plan 1 Work Plan Name: New Work Plan Expansion Months of Operation: 07/2013 - 06/2014 MM/YY - MM/YY County Mental Health Department Other Governmental Agencies Community Mental Health Contract Providers Total 30,034 $30,034 40,000 $40,000 8,000 $8,000 2,500 $2,500 2,000 $2,000 $82,534 $0 $0 $82,534 $0 $0 $0 $0 $82,534 $0 $0 $82,534 $82,534 $0 $0 $82,534 $82,534 $0 $0 $82,534 Prepared by: 10-May Telephone Number: [PHONE REDACTED] Chris Stewart Date: C. Yearly Total Funding Requirements 3. Total New Revenue 4. Total Revenues 2. Additional Revenues b. (insert source of revenue) c. (insert source of revenue) B. Yearly Revenues 1. Existing Revenues 6. Total Proposed Work Plan Expenditures a. (insert source of revenue) A. Yearly Expenditures 1. Personnel Expenditures 4. Training Consultant Contracts 5. Work Plan Management 2. Operating Expenditures 3. Non-recurring expenditures Fiscal Year: ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 28 INNOVATION WORK PLAN BUDGET NARRATIVE (2013-2014) Summary: The funding request for Fiscal Year 2013-2014 represents the initial start-up (5 months of project implementation). A) Expenditures 1. Personnel Expenditures = $30,034.00 Personnel expenditures will include a licensed clinician and a program director. 2. Operating Expenditures – 40,000.00 Operating expenditures include rent, desktops, phones, program equipment, materials, and supplies. Administrative support costs are also included. 3. Non-recurring expenditures - $ 8,000.00 Non-recurring expenditures will include office furniture, toys, and other items to support the Integrated Family Wellness Center. 4. Training Consultant Contracts - $2,500.00 Comprehensive staff training will be conducted in the planning and development phase of the project. Ongoing and continuous training will also be developed for the project. In some instances, travel may be required, e.g., participation in statewide training activities. Evaluation efforts will be an integral component to the integrated family wellness advisory board, to identify validated tools for assessing program objectives. 5. Work Plan Management - $ 2,000.00 Work plan management will support the MHSA Planning Committee’s efforts to lead the project implementation. 6. Total Proposed Innovation Work Plan Budget - $82,534.00 B) Revenues 1. Other Revenues - $ 0 ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 29 Innovation Projected Revenues and Expenditures (2013-2016) Alpine County Behavioral Health - INN Year 1 Year 2 Year 3 Total A. Yearly Expenditures 1. Personnel Expenditures 30,034 30,033 30,033 $90,100 2. Operating Expenditures 40,000 40,000 40,000 $120,000 3. Non-recurring expenditures 8,000 500 500 $9,000 4. Training Consultant Contracts 2,500 2,500 2,500 $7,500 5. Work Plan Management 2,000 2,000 2,000 $6,000 Total Proposed Work Plan Expenditures $82,534 $75,033 $75,033 $232,600 B. Yearly Revenues 1. Existing Revenues 2. Additional Revenues a. (insert source of revenue) b. (insert source of revenue) c. (insert source of revenue) 3. Total New Revenue $82,534 $75,033 $75,033 $232,600 4. Total Revenues $82,534 $75,033 $75,033 $232,600 C. Yearly Total Funding Requirements $82,534 $75,033 $75,033 $232,600 ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 30 Appendix A ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 31 Appendix B Date Name Telephone # Interviewer Interview Overview Script I am ________calling from Resource Development Associates (RDA). Alpine County has contracted RDA to help collect information to develop an MHSA Innovation project plan in your community. Your feedback will be invaluable in developing Alpine’s MHSA Innovation plan. Thank you for participating in the one-hour interview. These interviews are confidential. Your name will not be attached to the answers you provide unless we specifically ask your permission. Background: MHSA Innovation This year, Alpine County is planning to use MHSA funding to develop an Innovation project to address the unmet behavioral health needs of the community. Innovation components should do at least one of the following: Increase access to services Increase access to underserved groups Increase the quality of services, including better outcomes Promote interagency communications Above all, an Innovation project must be a new practice or approach to service delivery. Do you have any questions before we start? I have a list of questions to review today and I will be typing notes while you are responding. ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 32 Increase Access to Services 1. Briefly describe what mental health services are available. 2. How do people access mental health services how and why)? 3. Please describe any barriers to accessing mental health services. a. Are these ongoing barriers (follow up)? b. What are some of the reasons causing these barriers/challenges (follow up)? 4. Describe ways that could improve access to mental health services. Increase Access to Underserved Groups 5. What population is underserved? 6. Do the underserved currently access mental health services? a. If yes, under what circumstances? b. If not, what are the reasons? 7. Why do you think this population continues to be underserved? Increase the Quality of Services, Including Better Outcomes 8. If the needs were met, what would it look like? a. Describe how this could be accomplished (follow up). Promote Interagency Communications 9. Describe how mental health agencies (e.g. providers, government agencies) work together. 10. In what ways can mental health agencies improve access to mental health services? 11. In what ways can mental health agencies meet the needs of the underserved? Those were all the questions I had for today. Are there any other questions or comments you would like to add? That concludes our interview, thank you so much for your time and input. Findings from these interviews will be presented during the County’s Innovation Work Session on Tuesday, February 26 from 10 AM to 4 PM. ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 33 Appendix C Instructions: Please identify a Reporter and a Scribe (it can be one person). At the end of this activity, the designated reporter will present your ideas to the larger group. Activity Overview: The main purpose of this exercise is to identify unmet mental health needs, the underserved population, and programs that do not currently exist. Try to reach consensus if possible, if not, include everyone’s perspective. Please spend time discussing before filling out this form. Use as much space as you need, and feel free to attach an additional page. Note: There are no wrong answers. Name of 1. Who are the underserved population? What group do you believe is not accessing mental health services? 2. What are the unmet mental health needs? ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 34 3. What are the barriers to accessing services? 4. What would it look like if programs served the underserved population and mental health needs were met? Refer to question 5. What do you want to learn from these new programs? What main program goals will be met? ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 35 Appendix D Worksheet Responses Tuesday, February 26, 2013 1:00 PM – 4:00 PM Alpine County facilitated the MHSA Innovation Planning Work Session to identify county issues and needs. The notes below summarize the identification of program needs, underserved populations, ideal program services, and program priorities. A. Parent involvement in education, 0-5 children: 1. Underserved Population: 0-4 population- no care, no support. Parent involvement needed (education, helping parents learn how to listen to and support children positively.) 2. Unmet Needs: 0-5 children / parent involvement. Social/emotional skills. Support. Parents education. Play groups. Observation by other parents and providers. 3. Barriers to Access: No place for building development (e.g. other wellness center). Limited eligibility. Issues with labels, income, trust issues, transportation, and knowledge of services. There is a lack of understanding available services; therefore, parents are unwilling to participate. 4. Ideal Service: Social/emotional skills are what they learned now not then. Specialized treatment is available when needed. We need dependable program and funding. Cultural – all (international). Needs include: Facility with room for education, wellness and full kitchen, observation classrooms, and parenting classes- age expectations. Appropriate staffing is needed to catch early signs of developmental issues/needs. The purpose is to have happy healthy children, in a thriving community. Everyone lives in the” now” with the new youth. Trust building is important. Summary of service needs: a. Facilities w/ room for education, observation, kitchen b. Parent workshops c. Involve and educate about ALL international cultures d. Weekly specialized services w/ screening e. Social and emotional skills NOW 5. Want to Learn: Parents understanding their children (needs, wants of both, listening). Understand each other through learning about each other. Parents are educated creating a strong bonded community. B. 0-5 children: ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 36 1. Underserved Population: Everyone 0-5 years, including the elderly. Frontier localities/distance. 2. Unmet Needs: Historical mistrust. Through outreach- more activities. Social support- building. Learned behavior- more exposure. 3. Barriers to Access: Location- labeling/stigma/fear. No childcare. Lack of trust. 4. Ideal Plan: Consistent transportation to Daycare and jobs. Open communication to have a thriving community. We need to work better together. Increase trust and care for children. Provide a healthier/thriving county with comprehensive children services. Provide Daycare— with certified staff, who are culturally competent w/ Washoe community. Plan should incorporate strong personal parent involvement. a. Staff certified, culturally competent, and certified by tribe (certified to watch and monitor children, tribe recognized) b. Integration w/ physical health c. Integrated day care w/ screening services 5. Want to Learn: Transportation—one form meets all needs of population. Staff are also drivers, instructors, and could be volunteers. Facility will address program structural needs. People can come together in numerous ways to bridge cultural / social gaps for themselves and families – neutral environment. C. Geographically-isolated Individuals and/or families: 1. Underserved Population: Individuals who are geographically-isolated. Families in all demographic areas of the county. Families that have small children (under age 5) difficulty in going to work, attending school, etc. Lack of childcare, lack of transportation, etc. Those individuals with needs but have limited access to services or education. 2. Unmet Needs: Depression due to trauma, isolation, historical grief, lack of employment, perinatal mood disorder supports/information. There are also Blood quantum issues resulting in identity issues in the family unit (mother, father, children, aunts, and uncles, grandparents). 3. Barriers to Access: Transportation. Education for families that are expecting a child. Lack of a (one) contact person/location for services. What is mental health? Do I fit the criteria? There is also significant confusion around which jurisdiction will handle crises. 4. Ideal Service: We would have a localized contact person who was informed of all resources— tribe and county with strong connections to the Family Justice Center. We would have an additional transport person for mental health purposes. Services should become available during the weekends. All families would be educated on how to access mental health services. Individuals or families would be healthy and feel safe and secure, knowing that these services are trust worthy. Increase clinical staff that are specialized in diverse populations and or in pre- school aged children. Ideally mental health clinician would be someone from the Washoe tribe. a. Have a localized contact person with a family justice background to act as a “Resource Specialist” b. Have a transportation person available on weekends to increase community engagement/utilization ---PAGE BREAK--- Alpine County Behavioral Health Department MHSA Innovation Plan May 10, 2013 I 37 c. Increase the number of clinical staff specialized in underserved populations 5. Want to Learn: Have an informed community that trusts the mental health system with accessible transportation. Learn if people are getting to where they need to go and are receiving the information they requested. This includes having clinical services to help decrease substance abuse, address mental health issues, and linkages to appropriate medical care. Service outcomes should help families break the cycle of addiction, violence, child abuse, to live healthy and productive lives. D. 0-3 children with special needs and parents who are in denial or are unaware of their infants’ needs: 1. Underserved Population: Children 0-3 and families with special needs children. Families who don’t acknowledge their infant has a special need. Denial or unaware. 2. Unmet Needs: Mentors, parenting skills, access to education, early screening, appropriate diagnosis and medical support, therapeutic support, peer support groups, and transportation to the Alta Regional SLT, and tribal services. 3. Barriers to Access: Parents are unsure how to detect special need in their infant children. There is a need for more transportation funding (“rider ship”), increase in computer access to improve education and awareness, and funding for therapeutic tools. Barriers also residents’ feelings of discrimination, lack of affordable housing and families experiencing violence. 4. Ideal Service: Services should foster an atmosphere that supports healthy relationships and trust to increase engagement in the community. Family/parents should learn from each other through their interactions and gain skills. One stop shop for services (one room, OT, PT, infant specialist), parenting (one room). Program should become a collaborative interagency system of care. a. Increase early screening of needs and preventive services b. Atmosphere will encourage trust and engagement c. Centralized system of care (continuum of care to address children 0-3 special needs) 5. Want to Learn: Improved access to services. Decreased isolation and increase trust that fosters parenting education with a shared vision to create a system of care. Prioritization Participants prioritized their top three program ideas for the Innovation Project: 1. C – Geographically-isolated Individuals and/or families 2. A – Parent involvement in education, 0-5 children 3. D – Children 0-3 with special needs and parents who are in denial or are unaware of their infants’ needs