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This fragmentation involves the separation of mental health, physical health, and substance abuse services. It is explicitly considered a major impediment to service quality and good outcomes.”* (LAbizPlan.txt – Addressing Mental Health System Fragmentation in LA County) * Introduction to the Novation Motivation Model as a Strategic Solution * **Supporting Evidence:** > *”N’OVATION MOTIVATION BY OCEAN DURAN 2012. Emphasis: “OceanREmixED N’Mocean”. Purpose(s): understanding the ecology of procedures produced through the NRM (natural resource management) establishments of cooperative ecosystems and remonstrating the theoretical ontology coherent to the doctrine for OceansOntology101 by design methods.”* (LAbizPlan2.txt – N’OVATION MOTIVATION BY OCEAN DURAN 2012 – Purpose(s)) * Vision for a Cohesive, Client-Centered Mental Health System * **Supporting Evidence:** > *”The Novation Motivation model aims to create a streamlined, interactive system that remedies fragmentation, focusing on client-centered results and a ‘beneficially life experience’. The goal is a system where services flow together with the client’s journey, promoting wellness and recovery through integrated, collaborative efforts.”* (Conceptual Synthesis: LAbizPlan.txt – Integrating Concepts & LA County Mental Health Service Fragmentation and Innovation; LAbizPlan2.txt – Conclusion, Timeline) * Summary of Expected Outcomes and Impact * **Supporting Evidence:** > *”These beneficial “products” identify key roles that qualify proper placement and with qualitative resolve due to it’s structured components, in essence, the experience is a “beneficially life experience” which helps to define a need for a qualifying composition consisting of many types of variables that provide an innovative remedy for the cause.”* (LAbizPlan2.txt – Conclusion Reply 3) > *”The Innovations Plan’s highest priority is to ‘Increase the Quality of Services, including Better Outcomes’ by addressing fragmentation.”* (LAbizPlan.txt – Integrating Concepts for Mental Health System Innovation & Exhibit C, Overarching Concept) 2. **Understanding the Landscape: The LACDMH Context and the Imperative for Innovation** * 2.1. The Los Angeles County Department of Mental Health (LACDMH): Mission and Scope * **Supporting Evidence:** > *”The Los Angeles County Department of Mental Health (LAC-DMH) operates the largest mental health service system in the nation, serving approximately a quarter of a million residents annually. The department provides a diverse range of services, including assessments, crisis intervention, case management, and medication support in residential and outpatient settings.”* (LAbizPlan.txt – LA County Mental Health Service Fragmentation and Innovation) > *”The overarching goal of LAC-DMH is to ensure services are available for individuals most challenged by severe and persistent mental illness and to promote recovery, with key concepts including achieving positive outcomes, cultural appropriateness, and addressing disparities in access for ethnic, cultural, and underserved communities.”* (LAbizPlan.txt – LA County Mental Health Service Fragmentation and Innovation) * 2.2. The Core Challenge: Systemic Service Fragmentation * **Supporting Evidence:** > *”Based on the sources and our conversation history, system fragmentation is identified as a key overarching challenge for mental health services in Los Angeles County. This fragmentation involves the separation of mental health, physical health, and substance abuse services.”* (LAbizPlan.txt – Addressing Mental Health System Fragmentation in LA County) > *”Providers work for various agencies under separate systems, supervisors, regulations, and requirements… Clients often have separate charts and care plans… There are disparate and separate funding streams.”* (LAbizPlan.txt – Addressing Mental Health System Fragmentation in LA County) > *”This insufficient integration results in incomplete or inappropriate treatment for consumers. For individuals with serious mental illnesses, the failure to coordinate primary and behavioral health care has led to grave consequences, including chronic medical conditions and early mortality.”* (LAbizPlan.txt – Addressing Mental Health System Fragmentation in LA County) * 2.3. Disparate Impacts: Fragmentation’s Effect on Underserved Populations (Uninsured, Homeless, UREP) * **Supporting Evidence:** > *”Based on the provided sources and our conversation history, underserved populations are a central focus of the Los Angeles County Department of Mental Health (LAC-DMH) MHSA Innovations Plan. The plan prioritizes addressing the needs of these groups, who are identified as being greatly impacted by issues like decreased funding and system fragmentation.”* (LAbizPlan.txt – Los Angeles County Underserved Mental Health Innovations) > *”These underserved populations face significant challenges and barriers… Fragmentation of services… A fraying safety net… Stigma… Mistrust and fear of treatment, racism, discrimination… Lack of access to culturally and linguistically competent services.”* (LAbizPlan.txt – Los Angeles County Underserved Mental Health Innovations) * 2.4. LACDMH’s Existing Innovation Efforts and the Call for New Solutions * **Supporting Evidence:** > *”The MHSA Innovations (INN) Plan is the final MHSA plan to be implemented in LA County and is a plan focused on learning rather than service provision. The plan must focus on identifying new practices for the primary goal of learning and increasing the array of creative and effective approaches that can be applied to mental health services for specified populations.”* (LAbizPlan.txt – COUNTY OF LOS ANGELES – DEPARTMENT OF MENTAL HEALTH MHSA INNOVATIONS Plan, p.2) > *”The highest priority identified through stakeholder process was to Increase the Quality of Services, including Better Outcomes, by addressing this system fragmentation.”* (LAbizPlan.txt – LA County Mental Health Service Fragmentation and Innovation; Exhibit C, Overarching Concept) * 2.5. The Critical Role of Lived Experience in Shaping Effective Solutions * **Supporting Evidence:** > *”Based on the provided sources and our conversation history, lived experience is consistently highlighted as a profoundly valuable resource and a core component in efforts to innovate and improve mental health service delivery, particularly for underserved populations in Los Angeles County.”* (LAbizPlan.txt – The Power of Lived Experience in Mental Healthcare) > *”Individuals with lived experience have firsthand knowledge of navigating the fragmented system… Their experiences provide a practical, ground-level understanding of where the system breaks down… This awareness is considered vital for designing solutions that effectively address fragmentation.”* (LAbizPlan.txt – The Power of Lived Experience in Mental Healthcare) 3. **Proposed Solution: The Novation Motivation™ Model** * 3.1. Introduction: Novation Motivation™ – A Paradigm for Remedial Change * **Supporting Evidence:** > *”N’OVATION MOTIVATION BY OCEAN DURAN 2012. Emphasis: “OceanREmixED N’Mocean”. Purpose(s): understanding the ecology of procedures produced through the NRM (natural resource management) establishments of cooperative ecosystems and remonstrating the theoretical ontology coherent to the doctrine for OceansOntology101 by design methods.”* (LAbizPlan2.txt – N’OVATION MOTIVATION BY OCEAN DURAN 2012) > *”The “Media Arts” personify reality based structured design assessments, supporting the creation of applicable business practices as an innovative means to what is motivationally fueled!”* (LAbizPlan2.txt – Introduction: I. Artistic provisionary practices…) * 3.2. Foundational Philosophy: * **Supporting Evidence:** > *”This section introduces the core philosophical underpinnings of the Novation Motivation model, drawing from ‘OceansOntology101’ and the principles of ‘Systematic Resourcing’ to establish a unique approach to problem-solving and system design.”* (Conceptual Overview) * 3.2.1. OceansOntology101: Understanding Relational Dynamics * **Supporting Evidence:** > *”OceansOntology101 allows for correlating activities in which the purpose for “Resourcing; Networking Resources applies directly to my teachings about “healing”. In this design, I show and help you understand how to apply foundational philosophy that people these days join groups of meditation and gym activities for self healing. In this same light, I am able to relate business, and the body for success according to the business models.”* (LAbizPlan2.txt – Resourcing; Networking Resources) > *”Existence does not conform by chance, rather it lives based on the notion of how it relates in purpose to how it lives ‘now’ in its meaning or by what it stands next too so that it can relate to what it is being defined.”* (LAbizPlan2.txt – Reaction Realism Relative section) * 3.2.2. Systematic Resourcing: A Framework for Remedying Causes * **Supporting Evidence:** > *”Systematic Resourcing-1. Performance Production. 2 Resourcing process to help remedy a cause.”* (LAbizPlan2.txt – Critical Resource Functionality) > *”Systematic Resourcing: A basis for understanding what surrounds a centralized focus for remedial needs or innovation, involving performance production and a resourcing process to help remedy a cause.”* (LAbizPlan.txt – Mental Health Innovation and Human Capital Study Guide – Glossary) > *”This systematic resourcing of the performance production and resourcing process to help remedy a cause, is a basis on what surrounds the centralized focus of the current, greater formation produced naturally for remedial needs or innovation to the standard.”* (LAbizPlan2.txt – Conclusion Reply 2) * 3.3. Core Tenets and Operational Principles: * **Supporting Evidence:** > *”This section details the fundamental principles that drive the Novation Motivation model, including the strategic use of lived experience, environmental understanding, qualitative outcomes, structured implementation, and fostering proactive change.”* (Conceptual Overview) * 3.3.1. Leveraging Lived Experience as Expert Knowledge * **Supporting Evidence:** > *”Duran’s awareness of the lived experience of homelessness can be vital for the LAC-DMH plan… navigating years of homelessness while seeking help from various services… provides a deep, ground-level understanding of system fragmentation…”* (LAbizPlan.txt – Ocean Duran: Bridging Fragmentation Through Lived Experience and Strategy) > *”Personal Directives identify strengths and weakness to assess the goal and objectives are naturally created for procurement. A. Human capital gain and increase. B. Learning an innate ability to adapt in a situation by propositioning artistic methods as a practical work flow.”* (LAbizPlan2.txt – Personal Directives) * 3.3.2. Environmental Management and Interweaving Cultures for Holistic Support * **Supporting Evidence:** > *”A. Environmental Management. B. Interweaving cultures for developing new personal network relations.”* (LAbizPlan2.txt – Introduction: I. Artistic provisionary practices…) > *”The artistic mission is described as ‘Art imitating Life~2,’ utilizing ‘the greatest philosophical resource that we have in our societies… our ability for stimulating our environment.’ This leads to understanding relativity and forming correlating activities based on individual values.”* (LAbizPlan.txt – Mental Health Innovation, Art, and Community Process – Source 2) * 3.3.3. Qualitative Production & Performance: Achieving Tangible, Beneficial Outcomes * **Supporting Evidence:** > *”Qualitative Production Model. Performers Paramount is a formulation of strategies that allow for its production process to provide for performance… The final outcome is a reprocess of economic value that practices and involves the use of resources and networking.”* (LAbizPlan2.txt – Qualitative Production Model) > *”Production can be designed for qualitative results Performance can be designed for qualitative results. Persona allows for engaging…”* (LAbizPlan2.txt – Activities) * 3.3.4. Systematic Implements: Structured Processes for Learning and Progression * **Supporting Evidence:** > *”Systematic Implements. Systematic observations of formational elements which by its design for progression in the learning curve. Type cast and applies elemental structure according to artistic plans. Formulate business definition by documenting the artistic structure for each project coherent to the plan objectives.”* (LAbizPlan2.txt – OUTLINE: 1 Systematic Implements) > *”Systematic Implements: Defined as systematic observations of formational elements for progression in the learning curve, applying elemental structure according to artistic plans, and formulating business definitions.”* (LAbizPlan.txt – Mental Health Innovation and Human Capital Study Guide – Glossary) * 3.3.5. Fostering “Directional Movement”: Overcoming Systemic Inertia * **Supporting Evidence:** > *”Sound Trax 101 Composition of RPM (Rhythm Patterns N’Mocean) Situational Events recalling chronological events directing M’ocean for evidential outcomes.”* (LAbizPlan2.txt – Sound Trax 101) > *”What we want from a core products or purchase is seen in movement, when the object is “still” we then “act” to therefore involve the customer. The goal here is to see a Vision which provides for movement.”* (LAbizPlan2.txt – Timeline) > *”Fragmentation can be seen as a lack of ‘directional movement’ towards recovery and stability, where services remain ‘still’ in silos instead of flowing together with the client’s journey.”* (LAbizPlan.txt – Addressing Mental Health System Fragmentation in LA County, drawing from conversation history with Ocean Duran’s concepts) 4. **Strategic Application: Novation Motivation™ Addressing LACDMH Fragmentation** * 4.1. Deconstructing Fragmentation: A Novation Motivation™ Perspective * **Supporting Evidence:** > *”This systematic resourcing of the performance production and resourcing process to help remedy a cause… allows for a base structure to become apparent through streamlining a work flow order and finding weaknesses.”* (LAbizPlan2.txt – Conclusion Reply 2) > *”Duran’s focus on understanding processes and workflows relates to analyzing these breakdown points [of fragmentation].”* (LAbizPlan.txt – Addressing Mental Health System Fragmentation in LA County, referencing Duran’s perspective) > *”The true success from contributing ideas comes from organizing information and implementing a strategy to the work order and streamlining it to perceive an actual base structure already there.”* (LAbizPlan2.txt – Reaction Realism Relative section) * 4.2. Enhancing Inter-Agency and Community Collaboration (Interactivity) * **Supporting Evidence:** > *”Fragmentation is fundamentally a lack of interactivity between different parts of the system – providers, agencies, funding streams, data systems. Duran’s vision of collaborative ‘production’ aligns directly with the need for improved communication, coordination, and information sharing.”* (LAbizPlan.txt – Integrating Concepts for Mental Health System Innovation – Interactivity) > *”Community involvement as a co-operative work flow, allows for executive positions to create the functional productivity on behalf of community support.”* (LAbizPlan2.txt – III. Infrastructure and design awareness) > *”Applicant Statement: Influential means within the community of the arts network the community so that it streamlines the process of creating a production into a fully functional system. The ability to educate the process of what is forged into a systematic means relies on how we can outsource external influences.”* (LAbizPlan2.txt – IV. Growth development within performance) * 4.3. Integrating with and Enhancing LACDMH’s Existing Innovative Models * **Supporting Evidence:** > *”The Innovations Plan proposes four innovative models designed to integrate services and counteract this fragmentation: Integrated Clinic Model; Integrated Mobile Health Team Model; Community-Designed Integrated Service Management (ISM) Model; Integrated Peer-Run Model.”* (LAbizPlan.txt – Addressing Mental Health System Fragmentation in LA County) > *”Novation Motivation can provide a meta-framework or an operational philosophy to enhance the collaborative and process-oriented aspects of these existing LACDMH models, focusing on ‘qualitative resolve,’ ‘directional movement,’ and leveraging ‘lived experience’ and ‘systematic resourcing’.”* (Conceptual Synthesis based on LAbizPlan.txt & LAbizPlan2.txt) * 4.4. Empowering Underserved Populations through Culturally Coherent Engagement * **Supporting Evidence:** > *”The Community-Designed Integrated Service Management (ISM) Model: Explicitly focuses on Under-Represented Ethnic Populations (UREP)… addresses fragmentation by building on community strengths and allowing communities to define care within trusted institutions.”* (LAbizPlan.txt – Los Angeles County Underserved Mental Health Innovations) > *”Interweaving cultures for developing new personal network relations… Qualitative expectations for artistic direction, helping to structuring new development.”* (LAbizPlan2.txt – Introduction & Systematic Implements) > *”To provide effective mental health treatment to UREP communities, the public mental health system must adopt culturally competent and holistic strategies anchored in and supported by UREP communities that complement and enhance formal mental health services.”* (LAbizPlan.txt – Mental Health Innovation, Art, and Community Process, Source 1, Community-Designed ISM Model) * 4.5. Utilizing “Performers Paramount” as a Model for Collaborative Service Delivery * **Supporting Evidence:** > *”Performers Paramount is a formulation of strategies that allow for its production process to provide for performance, providing support for the arts and entertainment to produce outreach programs. Its structure implies that each component involved is also a performer by how it is able to facilitate within the production process.”* (LAbizPlan2.txt – Qualitative Production Model) > *”The Performers Paramount comprises of a skillful team with the innate ability to redefine the entertainment community… each organization is propositioned to perform within their own business practices.”* (LAbizPlan2.txt – Team Qualifying Productions) 5. **Implementation Framework: Bringing Novation Motivation™ to LACDMH** * 5.1. Phase 1: Pilot Program Development and Stakeholder Engagement * **Supporting Evidence:** > *”In designing a Community Program Planning Process for the Innovations Work Plan, Los Angeles County Department of Mental Health (LAC-DMH) sought to create a planning process that would invite innovative ideas and strategies… The extensive and intensive planning process began in early May 2009…”* (LAbizPlan.txt – EXHIBIT B, INNOVATION WORK PLAN Description of Community Program Planning and Local Review Processes, Page 1 of 4) > *”This phase focuses on adapting the Novation Motivation model to the specific context of LACDMH through collaborative workshops with stakeholders, defining clear pilot objectives, and selecting appropriate sites/programs for initial implementation.”* (Conceptual Elaboration) * 5.1.1. Identifying Pilot Sites and Target Populations within LACDMH * **Supporting Evidence:** > *”The Delegates also agreed to prioritize three populations greatly impacted by the above issues – the uninsured, homeless, and underrepresented ethnic populations (UREP), specifically African/African American, American Indian/Native American, Asian and Pacific Islander, Eastern European/Middle Eastern, and Latino communities.”* (LAbizPlan.txt – EXHIBIT B, Page 1 of 4) > *”The target populations for each of the above four models are the uninsured, homeless, and members of UREP with an emphasis on different combinations depending on the strategies used.”* (LAbizPlan.txt – EXHIBIT C, Page 4 of 11, Innovation Work Plan Narrative) * 5.1.2. Collaborative Design with LACDMH Leadership, Staff, and Community Partners * **Supporting Evidence:** > *”LAC-DMH utilized the following four primary structures for gathering input and developing the Innovations Plan: 1) Work Groups based on three Focal Populations; 2) Integration Team; 3) Integration Review Team; and 4) MHSA Stakeholder Delegates.”* (LAbizPlan.txt – EXHIBIT B, Page 3 of 4) > *”Cast of Characters: Marvin J. Southard, D.S.W.: Director of the County of Los Angeles Department of Mental Health (LAC-DMH)… Los Angeles County MHSA Stakeholder Delegates… Underrepresented Ethnic Populations (UREP) Subcommittees… Consumers, Families, Parents, and Caregivers…”* (LAbizPlan.txt – Mental Health Innovation Timeline and Participants) * 5.2. Phase 2: Training, Resource Mobilization, and “Systematic Implements” Rollout * **Supporting Evidence:** > *”This phase involves developing training materials based on Novation Motivation principles, conducting workshops for LACDMH staff and partners, and establishing the ‘Systematic Implements’ and ‘Systematic Resourcing’ protocols for the pilot.”* (Conceptual Elaboration) * 5.2.1. Developing Human Capital: Training in Novation Motivation™ Principles * **Supporting Evidence:** > *”A. Human capital gain and increase. B. Learning an innate ability to adapt in a situation by propositioning artistic methods as a practical work flow.”* (LAbizPlan2.txt – Personal Directives) > *”Assimilation (practices that re-evaluate the educating process) Producing promotional and practical strategies to create a plan for educative practices.”* (LAbizPlan2.txt – IV. Growth development within performance) * 5.2.2. Establishing “Systematic Resourcing” Protocols * **Supporting Evidence:** > *”Systematic Resourcing-Foundational exemplifications… By relating the production plan as a means to simultaneously fulfill the marketing plan, the artistic mission clarifies how the business plan will be set forth.”* (LAbizPlan2.txt – OUTLINE: 2 Systematic resourcing) > *”Critical Resource Functionality-(Philosophy of the “biz”) *Strategic Implements-Entertainment (choreography), Funding (resources) re-establishment of learning and experiencing growth in “real time”.”* (LAbizPlan2.txt – Critical Resource Functionality) * 5.3. Phase 3: Pilot Execution and “Qualitative Production” * **Supporting Evidence:** > *”This phase is the active implementation of the Novation Motivation model within the pilot sites, focusing on ‘Qualitative Production’ of services and monitoring ‘Directional Movement’ in client pathways and system operations.”* (Conceptual Elaboration) * 5.3.1. Implementing “Performers Paramount” Service Delivery Structures * **Supporting Evidence:** > *”The Performers Paramount comprises of a skillful team with the innate ability to redefine the entertainment community… each organization is propositioned to perform within their own business practices. This establishment is provisionary to the events process…”* (LAbizPlan2.txt – Team Qualifying Productions) > *”Its structure implies that each component involved is also a performer by how it is able to facilitate within the production process.”* (LAbizPlan2.txt – Qualitative Production Model) * 5.3.2. Monitoring “Directional Movement” and Adaptive Management * **Supporting Evidence:** > *”Sound Trax 101 Composition of RPM (Rhythm Patterns N’Mocean) Situational Events recalling chronological events directing M’ocean for evidential outcomes.”* (LAbizPlan2.txt – Sound Trax 101) > *”The true success from contributing ideas comes from organizing information and implementing a strategy to the work order and streamlining it to perceive an actual base structure already there. Therefore laying foundations, becomes irrelevant until the “situational order” becomes naturally fluent and flows as a streamlined order…”* (LAbizPlan2.txt – Reaction Realism Relative section) * 5.4. Evaluation: Measuring Impact and “Qualitative Resolve” * **Supporting Evidence:** > *”All four models will be reviewed and assessed for their effectiveness in producing system change outcomes, and they will be evaluated using the following six domains: 1. Integrated Care… 2. Service Levels/Access… 3. Quality of Care… 4. Community Improvement… 5. Stakeholder Satisfaction… 6. Cost…”* (LAbizPlan.txt – EXHIBIT C, Page 10 of 11, Project Measurement) > *”The Novation Motivation evaluation will align with these domains, emphasizing ‘qualitative resolve’ and client-defined ‘beneficially life experience’ as key metrics.”* (Conceptual Elaboration) * 5.4.1. Key Performance Indicators (KPIs) aligned with LACDMH goals and Novation Motivation™ outcomes * **Supporting Evidence:** > *”Outcomes: The benefits, changes or improvements that will result from your implemented program or project. Targets / Objectives: Projected level of success or result you hope to achieve.”* (LAbizPlan2.txt – Program examples of outsourcing documents) > *”Performance can be graded on how well something can provide satisfactory results… Expectations are also defined by the time quality opposite of performance.”* (LAbizPlan2.txt – Outcomes section under Activities) > *”More detailed client outcomes measures for this model to support the above may include: …Pre- and post-tests… Patient satisfaction surveys; Clinician satisfaction rates; Medication usage; Number of visits/utilization… Compliance with treatment goals…”* (LAbizPlan.txt – EXHIBIT C, Page 14 of 15, Integrated Clinic Model Project Measurement) * 5.4.2. Feedback Mechanisms from Service Users, Providers, and Community Stakeholders * **Supporting Evidence:** > *”LAC-DMH will survey the satisfaction of primary stakeholder groups, including clients and providers.”* (LAbizPlan.txt – EXHIBIT C, Page 10 of 11, Project Measurement, Domain 5) > *”The public hearing was held on November 19th, 2009, and the Commission moved to approve the Plan for submission to the State after the public was given an opportunity to provide their comments.”* (LAbizPlan.txt – EXHIBIT B, Page 3 of 4) > *”Regular feedback loops will be established through surveys, focus groups, and stakeholder meetings to ensure adaptive management of the Novation Motivation pilot.”* (Conceptual Elaboration) 6. **Anticipated Impact and Benefits for LACDMH** * 6.1. Enhanced Service Integration and Reduced Systemic Fragmentation * **Supporting Evidence:** > *”Stakeholders determined that successfully healing system fragmentation is a major impediment to service quality and good outcomes, making this the highest priority.”* (LAbizPlan.txt – Purpose of the Integrated Clinic Model, drawing from stakeholder input) > *”The primary purpose… is to ‘Increase the Quality of Services, including Better Outcomes’ by addressing ‘system fragmentation’.”* (LAbizPlan.txt – Mental Health Innovation, Art, and Community Process – Source 1, summarizing LACDMH INN Plan) * 6.2. Improved Quality of Care and Measurable Client Outcomes * **Supporting Evidence:** > *”The Los Angeles County Department of Mental Health (LAC-DMH) selected “Increase the Quality of Services, including Better Outcomes” as the primary purpose for the entire Innovations Plan…”* (LAbizPlan.txt – EXHIBIT C, Innovation Work Plan Narrative, Page 1 of 11, Work Plan Name: Overarching Concept to Innovations Plan) > *”Production can be designed for qualitative results.”* (LAbizPlan2.txt – Activities) > *”Developing a new level of understanding of the dynamics of various integrative models will point the way to creating new care models that may greatly improve outcomes…”* (LAbizPlan.txt – EXHIBIT C, p.5, Overarching Concept) * 6.3. Increased Accessibility and Engagement for Underserved Populations * **Supporting Evidence:** > *”The plan proposes four integration models to address… integrating mental health, physical health, and substance abuse services for the uninsured, homeless, and UREP.”* (LAbizPlan.txt – Innovative Mental Healthcare for Underserved Populations) > *”The Community-Designed ISM Model seeks to bridge the divide between ethnic communities and formal care providers by giving the communities themselves the opportunity to direct how mental health, physical health, and substance abuse services are integrated into trusted and established institutions of ethnic communities.”* (LAbizPlan.txt – EXHIBIT C, Page 4 of 16, Community-Designed ISM Model) * 6.4. Fostering a Culture of Continuous Learning, Adaptation, and Innovation * **Supporting Evidence:** > *”The MHSA Innovations (INN) Plan is… a plan focused on learning rather than service provision. The plan must focus on identifying new practices for the primary goal of learning…”* (LAbizPlan.txt – COUNTY OF LOS ANGELES – DEPARTMENT OF MENTAL HEALTH MHSA INNOVATIONS Plan, p.2) > *”Systematic Implements. Systematic observations of formational elements which by its design for progression in the learning curve.”* (LAbizPlan2.txt – OUTLINE: 1 Systematic Implements) > *”Each model will share its progress quarterly with the Systems Leadership Teamʼs INN Workgroup, a body that provides oversight for adjustments and documentation of learnings.”* (LAbizPlan.txt – EXHIBIT C, p.8, Timeline) * 6.5. Achieving “Beneficially Life Experience” and Enhanced Well-being for Los Angeles County Residents * **Supporting Evidence:** > *”These beneficial “products” identify key roles… in essence, the experience is a “beneficially life experience” which helps to define a need for a qualifying composition…”* (LAbizPlan2.txt – Conclusion Reply 3) > *”Duran’s models aim for ‘qualitative results,’ ‘qualitative resolve,’ assessing ‘impact,’ and providing a ‘beneficially life experience.’ Success is achieved through streamlining processes, creating opportunities, fostering growth, and satisfying needs.”* (LAbizPlan.txt – Integrating Concepts for Mental Health System Innovation – Paramount Success/Outcomes, summarizing Duran’s concepts) 7. **Organization and Management (Novation Motivation™ Initiative)** * 7.1. Proposed Initiative Leadership and Governance Structure * **Supporting Evidence:** > *”The Artistic Direction is lead by Choreographer Ocean Duran who facilitates the team’s formation by each of their strengths, and to meet the productions requirements accordingly, each organization is propositioned to perform within their own business practices.”* (LAbizPlan2.txt – Team Qualifying Productions) > *”This section would outline the proposed team structure for implementing Novation Motivation within LACDMH, detailing roles, responsibilities, and reporting lines, drawing parallels from how ‘Performers Paramount’ is organized for collaborative production.”* (Conceptual Elaboration based on LAbizPlan2.txt) * 7.2. Role of Ocean Duran: Lived Experience Expertise and Model Architecture * **Supporting Evidence:** > *”Ocean Duran / Ographer Ocean Duran / duran penamante: An artist, choreographer, and author of “MasterPiece N’Mocean” and “NovationMotivationByOceanDuran.pdf”. He explores themes of artistic mission, social realism, innovation, motivation, personal development, and systematic approaches…”* (LAbizPlan.txt – Mental Health Innovation Timeline and Participants – Cast of Characters) > *”by Ographer Ocean Duran. The various job cycles conducive to my “higher” learning in respects for remedial implications on the subjects of economics and entertainment, begins my artistic mission with research and development.”* (LAbizPlan2.txt – the Healing “ART”) * 7.3. Collaboration with LACDMH Personnel and Existing Structures * **Supporting Evidence:** > *”All four integration models were specifically designed to encourage community collaboration; to seek integrated service experiences for clients and their families…”* (LAbizPlan.txt – EXHIBIT C, Page 1 of 11, Overarching Concept to Innovations Plan) > *”Collaboration with LACDMH implies integrating Novation Motivation’s principles with existing teams, workgroups (UREP, Homeless, Uninsured), and stakeholder delegates, fostering a partnership approach to implementation.”* (Conceptual Elaboration based on LAbizPlan.txt – EXHIBIT B planning structures) * 7.4. Advisory Council: Incorporating Diverse Stakeholder Perspectives * **Supporting Evidence:** > *”The Los Angeles County MHSA Stakeholder Delegates, a countywide, diverse, and representative group specifically created to ensure wide and meaningful public participation in ongoing MHSA planning…”* (LAbizPlan.txt – EXHIBIT B, Page 1 of 4) > *”An advisory council for the Novation Motivation initiative would mirror the stakeholder engagement model of LACDMH, including consumers, families, UREP representatives, providers, and community leaders to guide implementation and ensure responsiveness.”* (Conceptual Elaboration) 8. **Financial Considerations (High-Level)** * 8.1. Estimated Resource Requirements for Pilot Program * **Supporting Evidence:** > *”When constructing the budgets for each model, LAC-DMH sought to use the broadest and most general outline for budgeted services in the hopes that this flexibility will allow bidding agencies an opportunity to submit proposals that are truly creative and innovative.”* (LAbizPlan.txt – MHSA Innovation (INN) Plan Overview of the Budget and Budget Narrative) > *”Resource requirements for a Novation Motivation pilot would include personnel for training and facilitation, materials, and potentially technology for communication and process tracking, to be detailed in a specific proposal.”* (Conceptual Elaboration) * 8.2. Potential for Leveraging Existing LACDMH Resources and MHSA Funding * **Supporting Evidence:** > *”In this Innovations Plan, LAC-DMH will leverage existing Federal and State funding, as well as community-based resources in order to maintain cost efficiency and maximize MHSA Innovations funding.”* (LAbizPlan.txt – EXHIBIT C, Page 11 of 11, Leveraging Resources) > *”Total Request for INN Funding $20,293,924 for Fiscal Year 2009/2010.”* (LAbizPlan.txt – EXHIBIT E Mental Health Services Act Innovation Funding Request, and cover letter) > *”The Novation Motivation pilot could be positioned as an enhancement or operational strategy for one or more of the existing INN models, thus potentially utilizing a portion of allocated INN funds.”* (Conceptual Elaboration) * 8.3. Long-Term Value Proposition: Cost-Effectiveness of Reduced Fragmentation * **Supporting Evidence:** > *”A variety of studies demonstrate that integrated models of health service delivery provide better health outcomes, improved consumer satisfaction, and fiscal savings.”* (LAbizPlan.txt – EXHIBIT C, Page 6 of 11, Contribution to Learning) > *”The goal is to deliver services in a cost-effective way.”* (LAbizPlan.txt – Purpose of the Integrated Clinic Model, referencing cost-effectiveness) > *”By streamlining processes and improving coordination, Novation Motivation aims to reduce inefficiencies associated with fragmentation, leading to better resource utilization and long-term cost benefits.”* (Conceptual Elaboration) 9. **Conclusion: Advancing Towards a Unified and Effective Mental Health System** * 9.1. Novation Motivation™ as a Catalyst for Transformative Change within LACDMH * **Supporting Evidence:** > *”REACHING FOR THE STARS; Ographer Ocean Duran brings forth his strengths, talents and skills to provide for a means to provide work and job opportunities… becomes the remedial component to what lacks in the present recession, directional movement.”* (LAbizPlan2.txt – Conclusion Reply 3) > *”The development of novel, creative and/or ingenious mental health practices and approaches that contribute to learning.”* (LAbizPlan.txt – COUNTY OF LOS ANGELES – DEPARTMENT OF MENTAL HEALTH MHSA INNOVATIONS Plan, p.2, INN funding goals) > *”Novation Motivation offers a systematic, experience-informed approach to foster the ‘directional movement’ needed to transition from a fragmented to an integrated, client-centered mental health system.”* (Conceptual Summary) * 9.2. Call to Partnership and Collaborative Implementation * **Supporting Evidence:** > *”LAC-DMH continues to work collaboratively with consumers, family members, parents, providers, other county departments, community groups and a number of planning bodies and organizations to ensure each plan is committed to the following concepts…”* (LAbizPlan.txt – COUNTY OF LOS ANGELES – DEPARTMENT OF MENTAL HEALTH MHSA INNOVATIONS Plan, p.2) > *”Contributions set forth for the show will exist based on the notion that each performer and crew member are all contributing to the show so that growth occurs, and a resourceful networking process creates for opportunities.”* (LAbizPlan2.txt – Outline section, end of Systematic Implements) > *”We invite LACDMH to partner in piloting the Novation Motivation model, leveraging collective wisdom and shared goals to build a more effective and humane mental healthcare system for Los Angeles County.”* (Conceptual Call to Action) 10. **Appendices** * Appendix A: Detailed Analysis of LACDMH Fragmentation Issues & Current Innovation Landscape * **Supporting Evidence:** > *(http://dmh.lacounty.gov Reply To: (213) 738-2321 Fax: (213) 351-2026 COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH BOARD OF SUPERVISORS GLORIA MOLINA MARK RIDLEY-THOMAS ZEV YAROSLAVSKY DON KNABE MICHAEL D. ANTONOVICH MARVIN J. SOUTHARD, D.S.W. Director RODERICK SHANER, M.D. Medical Director ROBIN KAY, Ph.D. Chief Deputy Director 550 SOUTH VERMONT AVENUE, LOS ANGELES, CALIFORNIA 90020 “To Enrich Lives Through Effect ive And Caring Service” December 1, 2009 The County of Los Angeles Department of Mental Health (LACDMH) hereby submits a request to amend its Mental Health Services Act (MHSA) Agreement to include an increased level of funding for Fiscal Year 2009-2010. The submission is for the review and approval of the LACDMH MHSA Innovation Plan (INN) consistent with the State Department of Mental Health Information Notice No. 09-02 released January 30, 2009. The total amount requested for the INN Plan is $20,293,924 for Fiscal Year 2009/2010. Pursuant to the Welfare and Institutions Code Local Review Process requirements, a 30-day public comment period was completed on November 18, 2009 and a Public Hearing was subsequently hosted by the Los Angeles County Mental Health Commission on November 19, 2009. Please find a summary of substantive public comments and questions included in the Appendix of our submission. Please direct any questions, comments, and/or revisions requests to: Gladys Lee, LCSW District Chief LACDMH Planning Division 213 251-6801 GLLee@dmh.lacounty.gov COUNTY OF LOS ANGELES – DEPARTMENT OF MENTAL HEALTH Mental Health Services Act (MHSA) INNOVATION (INN) PLAN Dr. Marvin J. Southard, DSW Director of Mental Health December 1, 2009 COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH COUNTY OF LOS ANGELES – DEPARTMENT OF MENTAL HEALTH MHSA INNOVATIONS Plan The Los Angeles County Department of Mental Health (LAC-DMH) strives to make Los Angeles communities better by partnering with consumers, families and community groups to create hope, wellness and recovery and by strengthening the capacity of communities to support recovery and resiliency. We improve the lives of thousands of people each year because we believe treatment works and recovery is possible. LAC-DMH serves approximately one-quarter of a million residents each year, making it the largest mental health service system in the nation. We provide a diverse spectrum of mental health services to all ages, including mental health assessments, crisis intervention, case management, and medication support in both residential and outpatient settings. Our diverse workforce includes psychiatrists, psychologists, social workers, medical doctors, clergy, and trained mental health consumers. Each year, LAC-DMH brings hope and recovery to hundreds of thousands of residents in all regions of Los Angeles County. Los Angeles County is one of the nation’s largest counties, with over 4,000 square miles, 88 different cities, and over 130 unincorporated communities. The County is home to over 10 million residents, a number exceeded by only eight states. One of the most diverse regions of the United States, dozens of languages are spoken by the County’s residents. Due to its large geographic size, Los Angeles County departments divide services into 8 regions called “Service Areas.” The eight Service Area (SA) regions include: SA 1 (Antelope Valley), SA 2 (San Fernando), SA 3 (San Gabriel), SA 4 (Metro), SA 5 (West), SA 6 (South), SA 7 (East), and SA 8 (South Bay/Harbor). California’s voters passed Proposition 63 (Mental Health Services Act – MHSA) in the November 2004 General Election. Proposition 63 aims to improve and transform the delivery of mental health services and treatment across the State of California. LAC-DMH has developed several plan components under MHSA, including: ­ Community Services and Supports (CSS) Plan; ­ Workforce Education and Training (WET) Plan; ­ Capital Facilities and Technology (CF/IT) Plan; and the ­ Prevention and Early Intervention (PEI) Plan The overarching goal of the above listed plans is to ensure the availability of services to children, youth, adults, and older adults most challenged by severe and persistent mental illness. LAC-DMH continues to work collaboratively with consumers, family members, parents, providers, other county departments, community groups and a number of planning bodies and organizations to ensure each plan is committed to the following concepts:  Promotion of recovery for all who struggle with mental illness, COUNTY OF LOS ANGELES – DEPARTMENT OF MENTAL HEALTH  Achievement of positive outcomes for all who receive mental health services,  Delivery of services in culturally appropriate ways, honoring the differences within diverse communities; and  Delivery of services in ways that address disparities in access to services, particularly disparities affecting ethnic, cultural and under-served communities The MHSA Innovations (INN) Plan is the final MHSA plan to be implemented in LA County and is a plan focused on learning rather than service provision. The plan must focus on identifying new practices for the primary goal of learning and increasing the array of creative and effective approaches that can be applied to mental health services for specified populations. INN funding should be used to accomplish the following:  The development of novel, creative and/or ingenious mental health practices and approaches that contribute to learning  The development of mental health practices and approaches through a community informed process that are representative of the communities to be served, especially unserved, underserved and inappropriately served communities  The development of new mental health practices and approaches that can be replicated and adapted to other populations and other counties if proven to successfully serve a specific population In addition to these goals, LA County, in collaboration with its stakeholders has designed INN models that promote community collaboration, and service integration for consumers and their families. These models focus on wellness, recovery, and resilience, are culturally competent; and are driven by consumers, family members, parents, and caregivers. We believe that thoughtful and well-constructed models will enable us to increase the quality of services and to improve outcomes for those served. EXHIBIT B INNOVATION WORK PLAN Description of Community Program Planning and Local Review Processes (Page 1 of 4) County Name: Los Angeles County Work Plan Name: Los Angeles County Department of Mental Health MHSA Innovations Plan 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) In designing a Community Program Planning Process for the Innovations Work Plan, Los Angeles County Department of Mental Health (LAC-DMH) sought to create a planning process that would invite innovative ideas and strategies that would lead the way to further recovery-oriented transformation in the public mental health system. Towards that end, we structured the process to be inquiry-oriented, flexible, adaptive, inclusive, and practical. The extensive and intensive planning process began in early May 2009 and picked up in earnest after the May 19th, 2009 election once funding for Innovations planning was assured. On February 18, 2009, the Los Angeles County MHSA Stakeholder Delegates, a countywide, diverse, and representative group specifically created to ensure wide and meaningful public participation in ongoing MHSA planning, endorsed a process that would focus the Innovations Plan on three critical questions faced by the County as it seeks to transform the public mental health system towards a recovery-oriented direction. The three critical issues requiring attention through innovative strategies were as follows: 1) the fraying safety net of mental health, health and other social services for the uninsured, as a result of decreased funding and growth in the number of uninsured persons; 2) the fragmentation of mental health, health, and substance abuse services; and 3) the decreased capacity to serve uninsured clients potentially displaced from services as a result of shrinking County General Funds. The Delegates also agreed to prioritize three populations greatly impacted by the above issues – the uninsured, homeless, and underrepresented ethnic populations (UREP), specifically African/African American, American Indian/Native American, Asian and Pacific Islander, Eastern European/Middle Eastern, and Latino communities. On June 24, 2009, the Stakeholder Delegates approved a planning structure to focus on the critical issues and targeted populations for innovations. That structure included the following: 1) broad public input; 2) work groups focused on the target populations; and 3) the inclusion of consumers, family members, parents, and caregivers in formal decision making roles. A visual depiction of that structure is included as Attachment A, EXHIBIT B INNOVATION WORK PLAN Description of Community Program Planning and Local Review Processes (Page 2 of 4) and the components of the planning structure are elaborated in section 2 of this Exhibit B. Announcements and invitations to participate in this process were extended to the public by the following means: 1) the Planning Division staff’s announcements at the regular Stakeholder Delegates meetings; 2) the Division of Empowerment and Advocacy which maintains close contact with consumers, family members, parents, and caregivers; and 3) the existing Los Angeles County Homeless Advisory Council; and 4) the five existing MHSA UREP subcommittees. Meetings were held in LAC-DMH offices or at St. Anne’s Residential Facility, a centrally-located community facility. In July 2009, three work groups began the planning process around the focal populations (uninsured, homeless, and UREP). Both the Homeless and UREP work groups were built upon existing MHSA Stakeholder subcommittees that worked together previously over the years; the Uninsured work group came together specifically for the Innovations Plan. These work groups would be responsible for vetting ideas to the next stages of consideration. LAC-DMH then requested the submission of innovative strategies from the public. One hundred five public submissions were received and reviewed by one or more of the work groups. In fact, most of the submissions were reviewed by two or three work groups. Submissions were received from contract agencies (54), community organizations (31), DMH consumer and family groups (12), non-DMH consumer and family groups (3), schools or universities (2), and others (3). A complete list of the submitted strategies is provided as Attachment B. The work groups had the liberty to combine strategies or invent new ones, informed by all the submissions. In the end, the work groups authored some innovative strategies through a process that included holding each other to a high standard of innovation. Finally, each work group forwarded up to five of the best innovative strategies to the Integration Review Team. A visual depiction of the process up to this point is included as Attachment C. At the end of August 2009, the Integration Review Team (IRT) examined the 15 proposed innovative strategies with an eye towards systems transformation. The IRT crystallized the learning goals that were within and across the three work groups and helped identify the strategies that spoke to those goals. The learning goals of the 15 strategies coalesced around the following four areas: 1) the leveraging of financial resources and maintaining sustainability; 2) the utilization of peer-run models; 3) the system-wide integration of mental health, health and substance abuse services; and 4) the engagement of ethnic community resources in the provision of services. In early September 2009, the Integration Team considered the four learning areas and concluded that all of the strategies and learning questions were seeking to address the fragmentation of care experienced by many in the system. From there, the Integration Team developed the critical question to be answered by the Innovations Plan: What are the most effective models for integrating mental health, physical health, and substance EXHIBIT B INNOVATION WORK PLAN Description of Community Program Planning and Local Review Processes (Page 3 of 4) abuse services in our defined focal populations of uninsured, homeless, and UREP? To answer that question, the Integration Team proposed to test the following four integration models as the Innovations Plan: 1) Integrated Clinic Model; 2) Integrated Mobile Health Team Model; 3) Community-Designed Integrated Service Management Model; and 4) Integrated Peer-Run Model. Visual depictions of these processes and their outcomes are provided as Attachment D. October 2009 was spent elaborating the four integration models consistent with the overarching learning question and the specific learning goals linked to the specific innovative strategies and developing the budget. The Plan was posted for public review on October 20th, 2009. The Delegates reviewed the Plan on October 21st, 2009 and again on November 18th, 2009, at which point they endorsed the Plan. The public hearing was held on November 19th, 2009, and the Commission moved to approve the Plan for submission to the State after the public was given an opportunity to provide their comments. 2. Identify the stakeholder entities involved in the Community Program Planning Process. LAC-DMH utilized the following four primary structures for gathering input and developing the Innovations Plan: 1) Work Groups based on three Focal Populations; 2) Integration Team; 3) Integration Review Team; and 4) MHSA Stakeholder Delegates. The following paragraphs outline which stakeholders comprised each structure, the responsibilities of each structure, and how decisions were made. A visual representation of the process is provided as Attachment A. Focal Population Work Groups – The three work groups were based on the County’s decision to target Innovations Funds on addressing the needs of uninsured, homeless and underrepresented ethnic populations (UREP). Each work group was co-led by a community leader and a LAC-DMH department lead person. Each work group was charged with generating ideas for innovative projects, reviewing public submissions for innovative projects, identifying and developing up to five Innovative Strategies for consideration by the Integration Review Team (IRT), and electing up to three additional representatives to the IRT. Within the work groups, participation was open to everyone, but voting was restricted to those who had attended meetings consistently so as to ensure continuity in the development of the Plan. Participants included consumers, family members, parents, caregivers, homeless advocates and experts, cultural brokers, providers of mental health, physical health, and substance abuse care and services and others. At all workgroup meetings there were opportunities to participate in languages other than English (most commonly in Spanish and Korean). Integration Review Team – The IRT consisted of the Integration Team plus up to three additional representatives elected by each of the work groups. The three representatives were chosen based on their ability and commitment to representing the EXHIBIT B INNOVATION WORK PLAN Description of Community Program Planning and Local Review Processes (Page 4 of 4) five innovative strategies from their work group. Priority was given to consumers, family members, parents, and caregivers. Of the 9 elected representatives, 6 were consumers, family members, parents, or caregivers. The IRT was responsible for developing and articulating the learning goals that were within and across the three work groups and helping to identify the strategies that spoke to those goals. The IRT also developed the details of each of the models along with content experts as needed. At all IRT meetings there were opportunities to participate in languages other than English. Integration Team – The Integration Team consisted of two Innovations Plan co-chairs (one community lead and one LAC-DMH lead) and the co-chairs of each of the focal population work groups. The Integration Team was responsible for reviewing the outcomes of the Integration Review Team and integrating their recommendations into a cohesive Innovations Plan. The Integration Team meetings also had opportunities to participate in languages other than English. MHSA Stakeholder Delegates – The Stakeholder Delegates is the primary recommendation-making body with regard to all MHSA planning. Many members of the Integration Team and work groups also participate in the Delegates process either as official representatives or alternates. Stakeholder Delegate meetings routinely have opportunities to participate in languages other than English. 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. The 30-day stakeholder review ran from October 20, 2009 through November 19, 2009. The public hearing was held on November 19, 2009, and interpreters were available for those speaking Spanish or Korean. Comments received during the review period and public hearing are included as Attachment J including those that were translated. EXHIBIT C (Page 1 of 11) Innovation Work Plan Narrative Date: _November 25, 2009__ County: _____Los Angeles County_______________________________________ Work Plan #: __n/a_____________________________________________________ Work Plan Name: ____Overarching Concept to Innovations Plan ______________ Purpose of Proposed Innovation Project (check all that apply) INCREASE ACCESS TO UNDERSERVED GROUPS √ INCREASE THE QUALITY OF SERVICES, INCLUDING BETTER OUTCOMES PROMOTE INTERAGENCY COLLABORATION INCREASE ACCESS TO SERVICES Briefly explain the reason for selecting the above purpose(s). While all four of the above purposes apply, the Los Angeles County Department of Mental Health (LAC-DMH) selected “Increase the Quality of Services, including Better Outcomes” as the primary purpose for the entire Innovations Plan through a stakeholder process that determined that its highest priority was to successfully heal the system fragmentation that is a major impediment to service quality and good outcomes. We have developed four models of integration based on an extensive community participation process that generated learning goals and innovative strategies that are salient to the communities and providers in Los Angeles County. All four integration models were specifically designed to encourage community collaboration; to seek integrated service experiences for clients and their families; to focus on wellness, recovery, and resilience; to be culturally competent; and to be driven by consumers, family members, parents, and caregivers. Thoughtful and well-constructed project designs will enable us to increase the quality of services and to improve outcomes by learning how features embedded in these four models will best provide integrated mental health, physical health, and substance abuse care to critical groups. All four proposed models have unique features that make them innovative and are detailed in the sections that follow. In addition, they share the innovation that comes from attempting to integrate physical health, mental health, and substance abuse services for specific vulnerable populations in a large, diverse urban environment and in a complex system of care. We believe that what we learn from these models can have broad applications in other similar urban environments such as Los Angeles. EXHIBIT C (Page 2 of 11) Innovation Work Plan Narrative 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) LAC-DMH seeks to determine the effectiveness of four distinct models for integrating mental health, physical health, and substance abuse services in defined focal populations of the uninsured, homeless, and under-represented ethnic populations (UREP). Throughout our Community Program Planning Process, LAC-DMH heard from its stakeholders that current care is fragmented, ineffective, and does not fully meet the needs of communities. To address this concern, LAC-DMH and its stakeholders sought to identify innovative strategies that addressed system fragmentation, that were meaningful learning goals for systems transformation, and that also offered opportunities to deliver recovery-based services to the uninsured, homeless, and UREP populations. Previous community research demonstrates that insufficient integration of mental health, physical health, and substance abuse services results in incomplete or inappropriate treatment for consumers. While Federal and State planning efforts look toward overcoming this historic and persistent fragmentation, mental health systems will be expected to play a major role. Despite these anticipated directives, there is a dearth of information regarding which integrative models will work best for populations with minimal resources and high mental health needs. Towards this end, LAC-DMH and its stakeholders developed four models of integration based on an extensive community participation process that generated learning goals and innovative strategies that are salient to the communities and providers in Los Angeles County. All four integration models were designed specifically to encourage community collaboration; seek integrated service experiences for clients and their families; focus on wellness, recovery, and resilience; will be culturally competent; and driven by consumers, family members, parents, and caregivers. The Four Integration Models The Integrated Clinic Model combines physical health, mental health, and substance abuse services in a community-based site, such as a primary care clinic or mental health clinic, to more fully address the spectrum of needs of individuals who are homeless, uninsured, and/or members of under-represented ethnic populations (UREP). This strategy seeks to increase access to the aforementioned services to those for whom services are fragmented and resources limited. This strategy could potentially EXHIBIT C (Page 3 of 11) Innovation Work Plan Narrative transform access in Los Angeles County as it increases the capacity for physical health, mental health, and substance abuse programs in organizations and systems where people in the community already go. It also seeks to increase the quality of services, including better physical health and mental health outcomes, as providers work together to coordinate care across practices. The utilization of existing infrastructure and the leveraging of other programs will create an efficient and cost-effective system that promotes interagency collaboration between Los Angeles County departments and providers. The Integrated Mobile Health Team Model is a client-centered, housing-first approach that uses harm reduction strategies across all modalities of mental health, physical health, and substance abuse treatment. This will be done in collaboration with the housing developers that have units available for this population in addition to accessing Federal housing subsidies and other housing resources. In this model, the primary goal is to address the fragmentation of services to the homeless population, many of whom are uninsured and are members of UREP. This model proposes to deploy a mobile, enhanced, integrated, multi-disciplinary team that includes physical health, mental health, and substance abuse professionals and specially-trained peers and that is managed under one agency or under one point of supervision. This model will develop individualized client care plans that contains physical health, mental health, and substance abuse client-centered treatment goals and objectives. Another unique feature of this model is that individuals will have access to the Integrated Mobile Health Team services through multiple points of entry, whether initially seeking assistance with physical health, mental health, substance abuse, or housing. It will increase access to services and leverage multiple funding sources including capital for housing development and Federal Qualified Health Center funding. The Community-Designed Integrated Service Management Model (ISM) envisions a holistic model of care whose components are defined by the community itself and also promotes collaboration and partnerships between regulated entities, contract providers, and community-based organizations to integrate health, mental health, substance abuse, and other needed care to support the recovery of consumers with particular attention to under-represented ethnic populations. The ISM model consists of discrete teams of specially-trained and culturally competent “service integrators” that help clients use the resources of both “formal” (i. e., mental health, health, substance abuse, child welfare, and other formal service providers) and “nontraditional” (i. e., community-defined healers) networks of providers, and who use culturally-effective principles and values. The ISM Model services are grounded in ethnic communities with a strong foundation of community-based, non-traditional, and natural support systems such as faith-based organizations, voluntary associations, and other service groups. In this model, ISM teams will integrate formal and informal provider and community-based resources through the following: 1) community-specific outreach and education; 2) EXHIBIT C (Page 4 of 11) Innovation Work Plan Narrative community-specific enhanced engagement practices; 3) enhanced linkage and advocacy; and 4) harmonious intertwining of formal and non-traditional services and supports through facilitation of inter-provider clinical communication. ISM teams will work with each client to ensure service access, coordination, understanding, follow-up, and inter-provider clinical communication. The teams will consist of both service professionals and specially-trained peers who will meet regularly with clients and provide information, transportation, motivation, encouragement, and help with provider communication. The Integrated Peer-Run Model supports people with mental health needs who also have additional health and/or substance abuse treatment needs to become well and stay well by providing new programs that are designed and run by people with lived experience of mental health issues. This model incorporates two innovative strategies: Peer-Run Integrated Services Management (PRISM) and Alternative Peer-Run Crisis Houses. PRISM is a client-driven, holistic alternative to traditional community mental health services that allows uninsured peers to secure needed physical health, mental health, and substance abuse options as part of a program designed to support and empower people to take responsibility for their own recovery. PRISM is based upon a “whatever it takes” philosophy in a context of personal choice. It consists of innovative specially-trained peer teams that share features of ISM teams in the Community-Designed ISM Model. As in the ISM model, the teams work with clients to ensure service access, coordination, understanding, follow-up, and inter-provider clinical communication. Also as with ISM teams, PRISM teams will meet regularly with clients and provide information, transportation, motivation and encouragement, and help with provider communication. However, unlike the teams in the ISM model, PRISM teams will consist entirely of specially-trained peers who will coordinate the provision of clinical services and coordinate and deliver peer-run/self help services. Peer-Run Crisis Houses are client-driven, holistic alternatives to hospitalization and are designed to provide a warm, safe, welcoming environment for uninsured people in psychiatric distress who are not a danger to others. These houses will be located in two places in separate service areas, and one of them will be dedicated to providing peer support to people in crisis who are being released from jail. Together, these strategies expand the range of peer-run options within the public mental health system. The target populations for each of the above four models are the uninsured, homeless, and members of UREP with an emphasis on different combinations depending on the strategies used. Each modelʼs description provides more detail on the numbers we project to serve and their demographic characteristics. As a whole, this Innovations Plan should provide critical services to a significant number of clients and their families with remarkable mental health, health, and substance abuse service integration needs, while also providing important data to help inform LAC-DMHʼs system transformation efforts. EXHIBIT C (Page 5 of 11) Innovation Work Plan Narrative Developing a new level of understanding of the dynamics of various integrative models will point the way to creating new care models that may greatly improve outcomes, reduce disparities for UREP populations, enhance service efficiency, increase consumer satisfaction, and carry the recovery-oriented skills and values of the public mental health system into the dimensions of physical health and substance abuse services. EXHIBIT C (Page 6 of 11) Innovation Work Plan Narrative 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) A variety of studies demonstrate that integrated models of health service delivery provide better health outcomes, improved consumer satisfaction, and fiscal savings. Existing large-scale successful models of integrated health, mental health, and substance abuse services (such as the Veterans Administration Healthcare System and Kaiser-Permanente) deliver care through a unified administrative system, which has both acknowledged advantages (such as relative ease of service coordination, standards development, and resource allocation) and disadvantages (such as limitations of size and scope, and relatively more difficulty utilizing other existing community resources beyond the integrated system). Successful integration of health care services has not been universal when it is attempted across multiple existing community agencies. While promising pilots have been attempted in a variety of settings, the degree to which we can usefully duplicate them has been limited by differences in funding, geography, ethnicity, and community resources. In a large urban area like Los Angeles County, successful integration of health services would critically benefit people who are uninsured, homeless, and members of UREP; yet the only practical way to integrate care is through use of existing agencies and resources. Limited attempts to do so are hampered by separate funding streams, intra-agency disagreements regarding target populations, limited referral mechanisms and expertise, and poorly defined outcome measures. To date, no single existing model for service integration clearly overcomes all these challenges. Therefore, the development of additional models specifically designed to overcome these limitations would be of great utility. What we learn could help intelligently guide both policy decisions and resource allocation for years into the future. Finally, each model pilot could provide important service benefits to many people while we answer fundamental questions for the future of health care delivery in the United States. During our Community Program Planning Process, we identified four learning goals for our Innovations Plan, captured in the following questions: 1. Can one or more multi-disciplinary models of fully integrated health, mental health, and substance abuse services using existing providers be embedded EXHIBIT C (Page 7 of 11) Innovation Work Plan Narrative within Los Angeles County community systems and result in the accurate identification and appropriate treatment of poly-occurring health, mental health, and substance abuse for uninsured, homeless, and UREP populations? 2. Can specifically identified formal and non-traditional ethnic community resources be engaged and utilized to increase access and improve the quality of mental health services for consumers from UREP communities? 3. Can the integration of mental health, physical health, and substance abuse treatment services generate a structure that leverages funding streams and results in a sustainable, integrated, and multi-disciplinary care that meets the multiple needs of people with mental health disabilities? 4. Can peer-run strategies result in effective coordination of health, mental health, and substance abuse services, including self-help modalities, while supporting recovery and wellness and increasing cost effectiveness? EXHIBIT C (Page 8 of 11) Innovation Work Plan Narrative 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) Implementation/Completion Dates: ____________1/10 – 12/12_______________ MM/YY – MM/YY The system changes proposed in these four integration models are challenging, and the extent of the fragmentation and barriers will not be fully understood until attempted. All integration models have been carefully constructed with a two-year timeframe for reaching LAC-DMHʼs learning goals and with an eye toward replication if any of the models prove successful. We believe a two-year timeline is sufficient to determine if barriers can be eliminated, fragmentation of services decrease, and replication is feasible. The lessons we learn will be shared with a variety of local, state, and national audiences such as LAC-DMHʼs Systems Leadership Team, MHSA Stakeholder Delegates, MHSOAC, CMHDA, and a variety of public policy forums. Each model will share its progress quarterly with the Systems Leadership Teamʼs INN Workgroup, a body that provides oversight for adjustments and documentation of learnings. We believe that our lessons may influence future evidence-based practices that will be disseminated across multiple systems.The more specific learning measures and activities are outlined in each modelʼs Timeline section, but the timeline below applies generally to our overall Innovations Plan: Timeframe Activities Jan 2010 Estimated Plan Approval from CA Dept of Mental Health Feb – Apr 2010 Competitive Bidding Process May – July 2010 Contract Negotiations, Board Approval and Awarding of Contracts Aug – Oct 2010 Start up and Staffing of Models Nov 1, 2010 1st Quarterly Formative Evaluation and Reporting Nov 2010 – Jan 2011 Service Provision continues EXHIBIT C (Page 9 of 11) Innovation Work Plan Narrative Feb 1, 2011 2nd Quarterly Formative Evaluation and Reporting Feb – May 2011 Service Provision continues June 1, 2011 3rd Quarterly Formative Evaluation and Reporting June 2011 – Aug 2012 Service Provision continues Sept – Dec 2012 Summative Evaluation/Final Report Share results and learnings with various local, state and national audiences. EXHIBIT C (Page 10 of 11) Innovation Work Plan Narrative Project Measurement Describe how the project will be reviewed and assessed and how the County will include the perspectives of stakeholders in the review and assessment. All four models will be reviewed and assessed for their effectiveness in producing system change outcomes, and they will be evaluated using the following six domains: 1. Integrated Care: To what degree was the model successful in integrating mental health, physical health, and substance abuse services? 2. Service Levels/Access: Did the model provide appropriate service levels for each population needed to achieve superior outcomes in the mental health, physical health, and substance abuse arenas? What were the barriers identified and how were they overcome? 3. Quality of Care: Did the model provide higher quality of care and achieve superior outcomes in the mental health, physical health, and substance abuse arenas? What were the barriers identified and how were they overcome? 4. Community Improvement: To what extent did the integration of mental health, physical health, and substance abuse services translate into community improvements? 5. Stakeholder Satisfaction: How satisfied were primary stakeholder groups with the services? LAC-DMH will survey the satisfaction of primary stakeholder groups, including clients and providers. 6. Cost: How well did the model facilitate the leveraging of available Federal, State, and community resources? LAC-DMH also will review the actual cost of delivering integrated care according to the model. We used the questions above to help us outline each model’s specific project measurements and goals, and they are described individually in each work plan. EXHIBIT C (Page 11 of 11) Innovation Work Plan Narrative Leveraging Resources (if applicable) Provide a list of resources expected to be leveraged, if applicable. In this Innovations Plan, LAC-DMH will leverage existing Federal and State funding, as well as community-based resources in order to maintain cost efficiency and maximize MHSA Innovations funding. Specific resources to be leveraged are listed within each modelʼs description. When constructing the budgets for each model, LAC-DMH sought to use the broadest and most general outline for budgeted services in the hopes that this flexibility will allow bidding agencies an opportunity to submit proposals that are truly creative and innovative. Cost estimates for each model were based primarily on the following three sources of data: 1) cost for outpatient services; 2) medication costs; and 3) data from stakeholders and subject matter experts for each specific model. A generation ago, carving out the mental health system was an important step in providing much-needed attention and resources to vulnerable populations. Now, health care integration figures heavily in federal healthcare reform efforts and in the renewal of the 1115 waiver. The Los Angeles County Innovations Plan provides a remarkable opportunity to explore new frameworks of care for individuals who are uninsured, homeless, and members of UREP. We expect that it may shed light on methods for integrating mental health, physical health, and substance abuse services that can usefully inform much larger future integration policy and implementation. Perhaps the most important contribution of the proposed Los Angeles County Innovations Plan would be to help ensure that in this round of possible reintegration of some aspects of the carve out, adequate attention will be paid to the needs of underserved and vulnerable populations of individuals living with mental illness. EXHIBIT C (Page 1 of 15) Innovation Work Plan Narrative Date: _November 25, 2009___ County: _____Los Angeles County_______________________________________ Work Plan #: __1_______________________________________________________ Work Plan Name: Integrated Clinic Model__________________________________ Purpose of Proposed Innovation Project (check all that apply) INCREASE ACCESS TO UNDERSERVED GROUPS √ INCREASE THE QUALITY OF SERVICES, INCLUDING BETTER OUTCOMES PROMOTE INTERAGENCY COLLABORATION INCREASE ACCESS TO SERVICES Briefly explain the reason for selecting the above purpose(s). While all four of the above purposes apply, the Los Angeles County Department of Mental Health (LACDMH) selected “Increase the Quality of Services, including Better Outcomes” as the primary purpose for the entire Innovations Plan through a stakeholder process that determined that its highest priority was to successfully heal the system fragmentation that is a major impediment to service quality and good outcomes. We have developed four models of integration based on an extensive community participation process that generated learning goals and innovative strategies that are salient to the communities and providers in Los Angeles County. All four integration models were specifically designed to encourage community collaboration; to seek integrated service experiences for clients and their families; to focus on wellness, recovery, and resilience; to be culturally competent; and to be driven by consumers, family members, parents, and caregivers. The Integrated Clinic Model seeks to increase the quality of care and services for uninsured people, including those who are homeless and/or members of UREP, by reducing the fragmentation inherent in the current system of care. This model will support the capacity of primary care or mental health clinics to integrate on-site mental health and substance abuse treatment services in an effective, culturally-relevant, and consumer-driven manner for individuals who are homeless, uninsured, and/or members of UREP. In this way, the model provides a “home” for people seeking integrated care. While other efforts to integrate care exist, our Integrated Clinic Model is innovative for several reasons. First, we are attempting to integrate care in a large, complex urban environment and in a system that includes directly operated and contracted entities. Second, the model specifically targets the most vulnerable populations to test whether integrated care improves service quality to them. Third, for those primary care sites integrating on-site mental health and substance abuse treatment services, this model extends the definition and scope of the mental health care to support and treat serious mental illness within the borders of a primary care site. Fourth, for those mental health sites that will imbed physical health and substance abuse services, the model’s EXHIBIT C (Page 2 of 15) Innovation Work Plan Narrative innovation includes the opportunity to stabilize the client enough to determine whether he or she can change the health home to a physical health site with support (e.g. moving the client to a wellness center or to a primarily physical health site as a move along the continuum of care). Lastly, this Integrated Clinic Model’s use of peers as staff is unique even among existing co-sited model design and systems of care. EXHIBIT C (Page 3 of 15) Innovation Work Plan Narrative 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 Integrated Clinic model combines physical health, mental health, and substance abuse services in community-based sites, such as primary care or mental health clinics, to more fully address the spectrum of needs of individuals who are homeless, uninsured, and/or members of underrepresented ethnic populations (UREP). This strategy seeks to increase access to the aforementioned services to those for whom services are fragmented and resources limited. This strategy can potentially transform access in Los Angeles County as it increases the capacity for physical health, mental health, and substance abuse programs in organizations and systems where people in the community already go. It also seeks to increase the quality of services, including better physical health and mental health outcomes, as providers work together to coordinate care across practices. The utilization of existing infrastructure and the leveraging of other programs will create an efficient and cost-effective system that promotes interagency collaboration between Los Angeles County departments and providers. A significant number of uninsured people seeking primary care or mental health services has general medical problems that are affected by stress, challenges in maintaining healthy lifestyles, or mental health issues. Whether or not people are physically ill and even how ill they are is not the primary determinant of whether they decide to visit a physician. Studies have suggested that only 12-25% of health care use can be accounted for by disability or morbidity alone. Nearly 70% of all health care visits have a psychosocial basis. Only half of the population that suffers from diagnosable mental disorders seeks any form of mental health care. Of the half that do seek care, 50% receive it solely from their general physician, meaning that half of all the behavioral health care in the U. S. is provided by general medicine providers.1 Recently published studies indicate that persons with serious mental illness in the United States can expect to live an average of 25 years fewer than the general population. Such results underscore the pressing need to improve and facilitate access to coordinated and integrated physical health, mental health, and substance abuse care. 























































 1 Source: Strosahl, K. (2002). Identifying and capitalizing on the economic benefits of integrated primary behavioral health care. In Cummings, O’Donohoe & Ferguson (Eds.) The impact of medica! cost offset on practice and research: Making it work for you. NV: Context Press.
 EXHIBIT C (Page 4 of 15) Innovation Work Plan Narrative In Los Angeles County, the need for improving access to and coordination of these services cannot be overstated. The Census 2008 American Community Survey found that 24.5% of the County’s population, 2.1 million, is uninsured. Of the nearly 1 million patients served by Los Angeles County’s primary care clinics in 2007, 63% (594,000) lived under the Federal Poverty Level. The majority seeking care in primary care clinics is uninsured, comes from UREP, and speaks a language other than English. These individuals face significant barriers to accessing services. Unfortunately, the stigma surrounding mental illness is one powerful barrier to reaching treatment, distinct from barriers related to cost, fragmentation of services, and lack of availability of services. Additional barriers deter members of UREP, such as mistrust and fear of treatment, racism and discrimination, and differences in language and communication. The Integrated Clinic model can reduce the stigma or difficulty in accessing services associated with formal health and mental health settings by relying on the trusted community resources and established relationships of existing community-level health and mental health providers. Further, providing services in the same site and on the same day as the initial visit can prevent the missed appointments that currently occur in a more fragmented system. The Integrated Clinic model is designed to serve the mental health, physical health and substance abuse needs of people who are uninsured, homeless, and/or UREP. The Integrated Clinic Model utilizes the “no wrong door” approach to services, meaning that clients can access the full suite of services by engaging a provider in any of the three disciplines at a single site. This model may also include the use of tele-medicine or tele-psychiatry. The Integrated Clinic model as structured here would provide services to an estimated 1,600 individuals over the course of a year at four planned clinic sites (400 individuals/year each). The Integrated Clinic will offer: • Cultural Competence: Targeted partners provide accessible, affordable, culturally-appropriate and non-discriminatory physical health or mental health care services to low-income families; • Wellness Focus: Providers will offer coordinated services with a focus on wellness in all disciplines; • An Integrated Service Experience: The model brings together systems with a common interest in providing care to the uninsured and medically indigent, restructuring the health care and mental health delivery system around an expanded network of public and private providers combining resources to improve the health and mental health outcomes of the underserved. This includes a capacity for peer involvement assisting clients with other services such as transportation, case management, linguistic support, and case management; EXHIBIT C (Page 5 of 15) Innovation Work Plan Narrative • Reduced Disparities in Access to Mental Health and Physical Health Services: Community-based providers serve the medically indigent populations that normally fall through the cracks of our health care system. Within the community primary care clinic and mental health system, American Indian, African/African American, and Latino users are overrepresented relative to their proportion in the Los Angeles County population; and, • Reduced Stigma and Discrimination: The model utilizes trusted community resources and non-traditional mental health settings. Integrating mental health services into the primary care setting can reduce the stigma associated with formal mental health settings. Integrating medical services into mental health settings will increase access of clients with serious mental illness into physical health care. At the core of the Integrated Clinic Model is the “warm hand-off” approach. For example, a patient enters a community clinic for a primary care appointment and establishes a medical home. During the encounter with the patient, the primary care provider conducts a simple mental health screening. Finding symptoms of a potential mental health condition, the provider can then call on the clinic’s mental health consultant to come to the exam room. Utilizing evidence-based assessment techniques and tools, the mental health provider then links the patient to the appropriate level of intervention matching the intensity of need. In another variation of the integration model where primary healthcare is embedded at a mental health site, screening and a warm hand-off approach is also utilized with the mental health provider performing the screening and hand-off to a physical health provider at the mental health clinic. This connection of services can reduce stigma in the mind of the patient and prevent the missed appointments that occur in a more fragmented system. This connection of services at the same site by the same team can also support the client’s comfort level in accessing and being understood as a client with serious mental illness at the point of care for physical health. Another core aspect in this model is care coordination. The objectives of care coordination are to facilitate access for high-risk populations and to promote coordination of social support and medical services across different organizations and providers, to ensure care and services at the appropriate level of care and to contain costs. Comprehensive care coordination enables people with special health or mental health care needs, especially those with chronic or complex conditions, to navigate through intricate care systems. Existing models of care coordination, including a number of chronic care and medical home partnerships, are demonstrating how health care can be delivered more smoothly and efficiently for people with chronic illnesses and complex needs. Care coordination and care management services to facilitate integrated access of mentally ill clients (particularly uninsured, homeless or a member of an underrepresented ethnic population) to mental health and healthcare resources is critical to ensuring access to physical health services. This intervention may serve to EXHIBIT C (Page 6 of 15) Innovation Work Plan Narrative narrow the startling difference in life expectancy that exists today when serious mental illness is one of the diagnoses. In addition to possessing the capacity to deliver mental health, physical health, and substance abuse services on-site, Integrated Clinic Models will also meet additional criteria for integrated care. Staff must include: peer staff, skilled care coordinators, benefits establishment coordinators, and licensed providers for health, mental health, and substance abuse treatment. The on-site care team may come from different agencies or may be staff hired within an agency for this particular integration purpose, but it must deliver integrated care including regular case conferencing, regularly updated unified care plan and follow up, and re-evaluated diagnosis and medications. Consumers, peer workers and family members, as appropriate, should be central to the initial care plan development, as well as ongoing revisions and updates to the plan. The Integrated Clinic Model must have the capacity to transmit necessary clinical and administrative information and link to high-level specialty mental health, specialty health, substance abuse, non-traditional services, and social services in the communities that they serve. Other required services and capacities are detailed in Attachment E. Participating sites will leverage recent public and private investments into the clinics’ technological infrastructure to assess the impact of this strategy on the mental health and physical health of the target population. Using disease management software, some clinics are already moving beyond the quality assurance efforts that are essential to ensure compliance by staff with protocols, practices, and documentation requirements. Such software efficiently and effectively advances quality improvement, tracks the effects of proven interventions on the uninsured individuals served, allows replication, and helps apply resources where they will do the greatest good. Integrated Clinic Models will have the capacity to track clients through a database and use an electronic integrated care plan that is standardized to support data collection for outcomes as well as other quality improvement efforts. Team Case Managers will assist clients through the service structure as well as track clients through the system. In addition, a network of linked services (care as well as community-based organizations) will be pre-established and documented in this model. The Integrated Clinic Model supports and is consistent with the General Standards identified in the MHSA and Title 9, CCR, section 3320. The model is grounded in the following specific principles and values: • Services are client-centered; • Prospective care is planned, facilitated, and coordinated; • Communication between providers is facilitated and enhanced; • Networks for clinical, non-traditional, or community-based referrals are established; • Peers are included in teams; • Services are timely; EXHIBIT C (Page 7 of 15) Innovation Work Plan Narrative • Care is safe; • Data-driven outcomes are both systems-focused and client-centered; • Services are efficient and quality-oriented; • Services are culturally competent; and, • Access to appropriate levels of care is provided. A more detailed description of the Integrated Clinic Model can be found as Attachment E. EXHIBIT C (Page 8 of 15) Innovation Work Plan Narrative 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) The Integrated Clinic Model changes an existing model of integrated care by applying it to specific, vulnerable populations in a large urban environment and complex care system. We expect that the model will help us understand how best to integrate mental health, physical health, and substance abuse care for uninsured, homeless, or under-represented ethnic populations in a complex urban environment such as Los Angeles. Specifically planned single-site focused coordination of health, mental health, and substance abuse care for uninsured people in Los Angeles County with significant mental health problems has not been previously attempted in a measured fashion. Also, this model builds the capacity within the primary health care and mental health systems to better serve the mental health, physical health, and substance abuse needs of persons across the spectrum of need and acuity. In this way, we will learn if uninsured, homeless, or UREP clients can be served in places where they already seek one kind of care and with less reliance on referrals for services outside the agency. Further, with the focus on health care reform and expanding care for the uninsured, this strategy offers Los Angeles County policy and practical lessons on how to shape its system to best operate under reform. The integration of primary care with mental health and substance abuse services is particularly important because it promises better outcomes in all areas. Through this model, the targeted population may achieve improved mental health status toward a wellness goal, improved physical health status, decreased utilization or need for crisis care, increased utilization of planned care through the clinic as medical home, and increased access for the those with mental illness. Better coordination of care is projected, as is better communication, planning, and shared clinical information between providers. The model may likely offer opportunities for skills enhancement among providers across systems and disciplines. Participating primary care staff members will almost certainly improve their understanding of mental health issues and interventions, and participating mental health members will improve their understanding of physical health issues. On a broader scale, this strategy will provide insight into: 1) new intervention techniques; 2) the impact of integrated care on Los Angeles County’s large and diverse population; 3) the relationship between physical and mental health costs and cost structures; and 4) the impact of current funding streams on the integration potential of the system. EXHIBIT C (Page 9 of 15) Innovation Work Plan Narrative Through our Community Program Planning Process, LACDMH and its stakeholders identified the following specific learning questions that would be answered by this model: 1. Can Los Angeles County expand and better coordinate services in order to improve health outcomes and better utilize limited public resources? 2. Can the capacity of the public mental health system be expanded to serve uninsured persons with high acuity levels? 3. Can integrated mental health and substance abuse services be provided at primary care settings? 4. Can integrated physical health and substance abuse services be provided at mental health settings? 5. How will persons of differing acuity levels access these integrated mental health and substance abuse services? 6. Will the imbedding of services at primary care settings decrease the stigma of clients receiving mental health services? 7. Will these persons achieve positive outcomes? 8. Can these services be delivered in a cost-effective way? EXHIBIT C (Page 10 of 15) Innovation Work Plan Narrative 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) Implementation/Completion Dates: ___________1/10 – 12/12________________ MM/YY – MM/YY The proposed system changes in this model are challenging, and the extent of the fragmentation and barriers will not be fully understood until attempted. All integration models have been carefully constructed with a two-year timeframe for reaching LACDMHʼs learning goals and with an eye toward replication if any of the models prove successful. We believe a two-year timeline is sufficient to determine if barriers can be eliminated, fragmentation of services decrease, and replication is feasible. The Integrated Clinic Modelʼs learning goals include testing the boundaries of integrated sitesʼ capacities to meet a wider range of physical, mental health and substance abuse needs beyond their usual capacity for the uninsured, homeless and members of UREP. To do this, we will need to develop the systemʼs capacity to track clients as they move through the system; and then track clients, their acuity levels and interactions with peer providers during the process. The lessons we learn will be shared with a variety of local, state, and national audiences such as LACDMHʼs Systems Leadership Team, MHSA Stakeholder Delegates, MHSOAC, CMHDA, and a variety of public policy forums. It is our intention that the information gained through this model will ultimately help LACDMH understand, shape and provide thoughtful definition to the future role and critical factors for specialty mental health in an integrated, person-centered health system. The timeline below applies generally to the Integrated Clinic Model: Timeframe Activities Jan 2010 Estimated Plan Approval from CA Dept of Mental Health Feb-Apr 2010 Competitive Bidding Process May—July 2010 Contract Negotiations, Board Approval and Awarding of Contracts Aug-Oct 2010 Start up and Staffing of Integrated Clinics Staff training Database and electronic care plan development Team orientation to the model MOUʼs and linkages for network finalization EXHIBIT C (Page 11 of 15) Innovation Work Plan Narrative Menu of services and administrative structure and process finalization Begin to see clients Nov 1, 2010 Clinics begin screenings, integrative processes and service delivery 1st Quarterly Formative Evaluation and Reporting Assessment of program, processes and preliminary data making adjustments as necessary Measure the number or percentage of patients screened by initial provider, referred to integrated partner, and referred outside to specialty care; measure acuity levels, peer involvement and other specific data. Nov 2010-Jan 2011 Screening and integrated care and services continues Feb 1, 2011 2nd Quarterly Formative Evaluation and Reporting Administrative and clinical staff meet for mid-program assessment with adjustment of program or processes as necessary. Measure the number or percentage of patients screened by initial provider, referred to integrated partner, and referred outside to specialty care; measure acuity levels, peer involvement and other specific data. Feb-May 2011 Continue Integrated Services June 1, 2011 3rd Quarterly Formative Evaluation and Reporting and adjustment of program or processes as necessary Measure the number or percentage of patients screened by initial provider, referred to integrated partner, and referred outside to specialty care; measure acuity levels, peer involvement and other specific data. June 2011-Aug 2012 Continue Integrated Services One year assessment and reporting of program, CQI efforts and outcomes measures, with program adjustments as needed. Create vision for next steps for continuation of program or change recommendations. Measure the number or percentage of patients screened by initial provider, referred to integrated partner, and referred outside to specialty care; measure acuity levels, peer involvement and other specific data. Also, measure the number or percentage of patients transitioned to primary care plus wellness center health home as permanent medical home. Sept-Dec 2012 Summative Evaluation/Final Report Assess results of evaluation and CQI efforts as basis for next steps in integration program and future efforts. Share results and learnings with various local, state and national audiences. EXHIBIT C (Page 12 of 15) Innovation Work Plan Narrative Project Measurement Describe how the project will be reviewed and assessed and how the County will include the perspectives of stakeholders in the review and assessment. Given Los Angeles’ geographic scope, population density, demographic diversity and mental health system’s complexity (which includes numerous directly operated and contracted entities), LAC-DMH stands to learn a great deal about implementing integrated clinic models, including the following: 1. For those primary care sites integrating mental health and substance abuse care, to what extent can they provide care for the Seriously Mentally ill patient and when will those patients need to be referred out to specialty mental health centers? 2. How will use of peers be accepted and utilized in these integrated models in Los Angeles and what will be the impact? 3. For those primary care sites integrating mental health and substance abuse care, what type of client and level of mental illness acuity will be seen and treated in the primary care practice and which will be referred for care with the on site mental health provider? 4. For those mental health sites integrating physical health care and substance abuse services, what type of client and level of mental illness acuity will be seen and treated in the mental health practice and which will be referred for continued care in primary care? These lessons, observations and data will help inform plans, designs and decisions of the Department of Mental Health to shape the future of specialty mental health as needed by our vulnerable homeless, uninsured and/or underrepresented diverse ethnic populations in Los Angeles. Below is a chart that broadly describes our measurement goals: Current State Desired State Goals Measures Mental Health / Physical Health/ Substance Abuse services located in different settings resulting in fragmented care. Single sites provide integrated services for mental health AND physical health AND Substance abuse services. Determine the extent to which each program site provides mental health AND physical health AND substance abuse services. Survey of program clients, providers, and administrators, and larger stakeholder community. Mental Health care & Physical care are located at different sites resulting in Integrated Care at common site to improve access and create more Determine the extent to which every program provides common site for Survey of program clients, providers, and administrators, and larger EXHIBIT C (Page 13 of 15) Innovation Work Plan Narrative diminished access for clients with Mental Illness. efficiency in the patient/person centered system. mental health, physical health and substance abuse care and services. stakeholder community. Current programs often have a lack capacity for communication coordination and sharing of information. Clinical, operational and other pertinent information is available to all on-site providers involved in patient’s care in a timely manner and supports prospective care planning and safety. Determine the extent to which each program changes or eliminates barriers to information sharing Identification and inventory of barriers as baseline and determination of the degree of change or elimination of identified barriers through survey of program clients, providers, and administrators, and larger stakeholder community. Many current programs lack capacity to fully integrate other community-based resources Community-based resources are integral service providers. Determine the extent to which each program increases the types and numbers of community-based partnerships and peer-provided services associated with integrated care sites. Measure the number of community-based partnerships and peer-provided services at selected program sites at the beginning of the program and at 18 months. Client must often go to multiple sites to receive care needed. Clients can receive necessary care at one site Determine the extent to which each program integrates and provides health, mental health, and substance abuse services at one site. Survey of program clients, providers, and administrators, and larger stakeholder community. Funding for integrated mental health, physical Funding for integrated mental health, physical Identify mechanisms for sustainable funding. Identify, inventory, and track core cost elements of EXHIBIT C (Page 14 of 15) Innovation Work Plan Narrative health and substance abuse programs is often difficult to sustain. health and substance abuse programs is ongoing. Identify care elements and cost of care elements for integrated care. integrated care, reimbursement sources and flow over duration of project. More detailed client outcomes measures for this model to support the above may include: 1. Screening tool usage (do primary care providers appropriately screen patients), and following referral protocols (do patients get referred to mental health when they screen positive) ; 2. Screening tool usage (do mental health providers appropriately screen patients), and following referral protocols (do patients get referred to PCP when they screen positive; 3. Pre- and post-tests (e. g., PHQ-9, Becks Anxiety Inventory, Brief Symptom Inventory, COJAK or other tools/in the case of warm handoff to physical health), screens may include no physical exam in last 12 months, Hx of Hypertension of diabetes, use of particular psychiatric medications etc.; 4. Patient satisfaction surveys; 5. Clinician satisfaction rates; 6. Medication usage; 7. Number of visits/utilization and level of care patterns; 8. Compliance with treatment goals; and, 9. Pre- and post-clinical indicators as appropriate. All outcomes will be monitored through standardized reporting as required by the Innovation Plan oversight structure. Outcomes data and evaluation results will be shared as required by the Innovation Plan oversight structure and as appropriate to advance treatment of this population in primary care and other settings. EXHIBIT C (Page 15 of 15) Innovation Work Plan Narrative Leveraging Resources (if applicable) Provide a list of resources expected to be leveraged, if applicable. MHSA funds will leverage local, State and Federal investments such as FQHC-330 funds, the State Expanded Access to Primary Care Program, and Los Angeles County’s Public Private Partnership to serve the greatest possible number of people. Through benefits establishment, providers will ensure that MHSA funds are not used to supplant existing funding and coverage sources. The estimated annual cost of the 4 proposed sites for implementation is $3,640,000 (i. e. $910,000 per site) Over two-years of initial MHSA INN funding this model will receive an estimated $7,280,000 of MHSA INN funding. These sites will serve an estimated 1,600 consumers annually (i. e. 400 per site) for outreach and engagement, assessment, treatment and/or referral services. Provision of outreach, engagement and assessment services may or may not result in ongoing treatment through the model but rather referral to other services. An estimated 20-25 percent of individuals receiving outreach and engagement services are expected to need on-going treatment for a full year (80-1 00 clients). EXHIBIT C (Page 1 of 11) Innovation Work Plan Narrative Date: _November 25, 2009___ County: _____Los Angeles County_______________________________________ Work Plan #: __2_______________________________________________________ Work Plan Name: __Integrated Mobile Health Team Model____________________ Purpose of Proposed Innovation Project (check all that apply) INCREASE ACCESS TO UNDERSERVED GROUPS √INCREASE THE QUALITY OF SERVICES, INCLUDING BETTER OUTCOMES PROMOTE INTERAGENCY COLLABORATION INCREASE ACCESS TO SERVICES Briefly explain the reason for selecting the above purpose(s). While all four of the above purposes apply, the Los Angeles County Department of Mental Health (LAC-DMH) selected “Increase the Quality of Services, including Better Outcomes” as the primary purpose for the entire Innovations Plan through a stakeholder process that determined that its highest priority was to successfully heal the system fragmentation that is a major impediment to service quality and good outcomes. We have developed four models of integration based on an extensive community participation process that generated learning goals and innovative strategies that are salient to the communities and providers in Los Angeles County. All four integration models were specifically designed to encourage community collaboration; to seek integrated service experiences for clients and their families; to focus on wellness, recovery, and resilience; to be culturally competent; and to be driven by consumers, family members, parents, and caregivers. One of the four service integration models is the Integrated Mobile Health Team Model which primarily seeks to increase the quality of services for individuals with a diagnosis of mental illness, and their families, who are homeless or have recently moved into permanent supportive housing (PSH) from homelessness through a specific set of strategies aimed at reducing the fragmentation of physical health, mental health and substance abuse care. This model proposes to use a mobile, enhanced, integrated, multi-disciplinary team which includes physical health, mental health, and substance abuse professionals. One of the main goals of the services provided through this model is to improve outcomes for individuals who have a mental illness and are homeless by assisting them to secure housing and to provide the supports necessary for them to retain their housing. Many of these individuals are uninsured, and are members of underrepresented ethnic and other groups. While other mobile team models exist, our Integrated Mobile Health Team model is innovative for several reasons. First, we are attempting to integrate care in a complex urban environment that is geographically widespread and maintain those services even after individuals move into permanent supportive housing. Second, the Integrated EXHIBIT C (Page 2 of 11) Innovation Work Plan Narrative Mobile Health Team will be managed under one agency or under one point of supervision, which is unusual in Los Angeles’ complex system of multiple departments and agencies. Third, it will increase access to services and leverage multiple funding sources including Federal Qualified Health Center (FQHC) funding and capital for housing development which have not previously been tapped. EXHIBIT C (Page 3 of 11) Innovation Work Plan Narrative 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) To end homelessness for some of the poorest and most vulnerable Los Angeles County residents, many with multiple disabling conditions, LAC-DMH and its stakeholders have designed a model that will reach out to these individuals who are located throughout the county using an Integrated Mobile Health Team. This model is innovative in that it will operate in a complex urban environment under one agency or point of supervision, and the model includes innovative leveraging of various funding streams to establish sustainable funding. The Integrated Mobile Health Team will also continue to provide services to individuals to whom they have outreached even after they have moved into permanent supportive housing. The use of project-based service vouchers in partnership with permanent supportive housing developers is another innovative aspect of the Integrated Mobile Health Team Model. The Integrated Mobile Health Team is client-centered and uses a housing-first approach with harm reduction strategies across all modalities of mental health, physical health, and substance abuse treatment. This will be done in collaboration with the housing developers that have units available for this population in addition to accessing Federal housing subsidies and other housing resources. In this model, the primary goal is to address the fragmentation of services to individuals who are homeless and who have mental health, physical health, and substance abuse treatment needs. Currently, multiple providers from various agencies with different funding streams serve these individuals. The providers may be co-located but have different supervisors, their own policy and procedures, including separate charts and care plans. These practices result in fragmentation which is a barrier to providing the optimal supports necessary for these individuals to successfully move from homelessness into permanent supportive housing (PSH) and to maintain their housing. To eliminate the fragmentation of services, the Integrated Mobile Health Team will be staffed with a multi-disciplinary team of mental health, physical health, and substance abuse professionals who work under one agency such as a Federally Qualified Health Center (FQHC) or one point of supervision. The Integrated Mobile Health Team will provide outreach and on-going services that are tailored to the specific needs of the individuals served whether they are living on the streets, in shelters or newly transitioned into PSH or living arrangements. They will travel with their supplies and will serve homeless individuals and their families where they reside or congregate such as on the streets and in shelters. This team will continue to serve these individuals and their families when they transition into PSH. A central feature of this model that will address the fragmentation of services is the development of one comprehensive client care plan that contains physical health, mental health, and substance abuse treatment EXHIBIT C (Page 4 of 11) Innovation Work Plan Narrative goals and objectives that are client-centered. Another unique feature of this model is that the access to services is based on the client’s identified need, whether it is housing, physical health, mental health, or substance abuse. All of these needs can be addressed immediately by the multi-disciplinary Integrated Mobile Health Team that includes physical health, mental health and substance abuse professional and specially-trained staff including housing/employment/benefit establishment specialists and peer/family/parent advocates. The Integrated Mobile Health Team will continue providing services to individuals who move from the streets and shelters into PSH units through the innovative use of a project-based service voucher. These vouchers will be committed to housing developers that are interested in building PSH and will be used to leverage housing capital to develop more PSH units. The project-based service vouchers will be dedicated to PSH units similar to the way that project-based operating subsidies are used to make the units affordable for a specific period of time. Developers will apply for project-based service vouchers for a specific number of PSH units dedicated to the MHSA focal population. LAC-DMH will make a commitment to the developer for a specific number of project-based service vouchers. The voucher indicates that the developer has access to integrated physical health, mental health, and substance abuse services provided by an Integrated Mobile Health Team. Funding will be tied to the housing units, but the service intensity will be based on the needs of the clients. In the event the client leaves the PSH project with the project-based service vouchers, the Integrated Mobile Health Team could continue to provide services regardless of their residence. We anticipate that over the next year approximately 400 PSH units will become available through the MHSA Housing Program and other housing development resources and that services will be needed by many of the individuals living in these units. This model is designed to serve individuals with a diagnosis of mental illness, and their families, who are homeless and are living on the street, in a shelter, or have recently moved into PSH from homelessness. Some of these individuals will be the most vulnerable homeless individuals as defined by the Common Ground Vulnerability Index or other methods based on community priorities that determine that those living on the street or in shelters and who have multiple disabling conditions are the most likely to die in the next year. Individuals will have access to the Integrated Mobile Health Team services through multiple points of entry, whether it is physical health, mental health, substance abuse, or housing. It is estimated that a total of 900 individuals and their families will be served each year (300 per team). This includes individuals who receive outreach services only and those that are engaged in more on-going services. The Integrated Mobile Health Team Model supports and is consistent with the General Standards identified in the MHSA and Title 9, CCR, section 3320. The model is grounded in the following specific principles and values: EXHIBIT C (Page 5 of 11) Innovation Work Plan Narrative • A housing-first model which will immediately assist individuals to transition from homelessness to housing by providing housing of the individual’s choice without any prerequisites/conditions for mental health treatment or sobriety. • Services are voluntary; • Services are in the client’s preferred language and are provided in a culturally competent manner; • Services are designed to reduce the risk of harm associated with certain behaviors such as drug abuse; • Services are driven by the client’s own goals and interests; • Holistic support including physical health, mental health, and substance abuse services, as well as services such as transportation, follow-up, encouragement, and communication is provided. • Natural support systems of specific communities are actively strengthened, so that these supports can be part of the clients’ recovery process; and, • Outcomes data are collected and analyzed in order to inform efforts for systems change. A more detailed description of the Integrated Mobile Health Team Model can be found as Attachment F. EXHIBIT C (Page 6 of 11) Innovation Work Plan Narrative 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) The Integrated Mobile Health Team Model contributes to learning by changing existing integrated service models which remain fragmented because of separate funding streams, charts, care plans, and lines of supervision. This model will provide important information and data that will help us understand how best to integrate mental health, physical health, and substance abuse care for homeless individuals with these treatment needs. Mobile teams are not the innovation; previous multi-disciplinary teams have worked together but have been hampered by accountability to different agencies and/or supervisors. This model will explore the effectiveness of having one point of supervision or accountability for the multi-disciplinary mobile team, which is unusual in a complex system such as Los Angeles with multiple departments and agencies. Previous multidisciplinary teams also found that disparate funding streams were barriers to integrating care. Therefore, this model will test the efficacy of “braiding” a variety of existing funding streams (such as FQHC, Medical, Drug Med i-Cal, and veterans programs) so as to better integrate the funding of services and consequently, the services themselves over the long term. This model also addresses the systemic need for increased permanent supportive housing units for clients with mental illness and their families. Borrowing concepts successfully used in Section 8 project-based rental subsidies, LAC-DMH plans to innovatively use project-based service vouchers to create a market that draws affordable housing developers and service agencies into a collaborative effort to increase the number of PSH units available. When partnered with Integrated Mobile Health Teams, project-based service vouchers can encourage the creation of both single-site and scattered-site permanent supportive housing. Through our Community Program Planning Process, LAC-DMH and its stakeholders identified the following specific learning questions that would be answered by this model: 1. How do we decrease the fragmentation of and barriers to services provided to the homeless population including those recently transitioned into permanent housing that inhibit collaboration and integrated care? 2. How do we successfully design and manage a fully integrated physical health, mental health, and substance abuse service delivery model that best leverages existing funding for physical health and substance abuse services (in addition to mental health services) and braid several different funding streams to ultimately become financially sustainable? EXHIBIT C (Page 7 of 11) Innovation Work Plan Narrative 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) Implementation/Completion Dates: _____________1/10 – 12/12______________ MM/YY – MM/YY The system changes proposed in this model are challenging, and the extent of the fragmentation and barriers will not be fully understood until attempted. Through a solicitation process, LAC-DMH will begin to find a qualified provider of these integrated services that can hire staff and develop and implement one integrated care plan addressing physical health, mental health, and substance abuse as indicated in the model. LAC-DMH anticipates that contractors with whom the LAC-DMH does not typically contract with for services, such as the Federally Qualified Health Centers, will be interested in implementing this innovative model. Also, LAC-DMH does not usually oversee contracted services that address physical health and substance abuse treatment needs, so we plan to work collaboratively with our partners at Department of Health Services and Department of Public Health, Alcohol and Drug Program Administration to develop, administer, and oversee the innovative Integrated Mobile Health Team Model. A two-year timeline is sufficient to determine if barriers can be eliminated and fragmentation of services decreased by contracting with qualified provider(s), developing a truly enhanced integrated mobile health team, and to determine the feasibility of successfully braiding the funding and fully leveraging other funding resources. The proposed timeline will allow sufficient time for learning and will provide an opportunity to assess the feasibility of replication. LAC-DMH anticipates that it will take the Integrated Mobile Health Team(s) a full 24 months of operation to address some of the more intractable barriers that have stymied past efforts to align charting, data collection, information sharing, and funding. Once the agreements and methods are in place for overcoming the barriers, they will be fully documented in order to replicate the approach widely. The lessons we learn will be shared with a variety of local, state, and national audiences such as LAC-DMHʼs Systems Leadership Team, MHSA Stakeholder Delegates, MHSOAC, CMHDA, and a variety of public policy forums. The timeline that follows is a general outline of activities for the Integrated Mobile Health Team Model: EXHIBIT C (Page 8 of 11) Innovation Work Plan Narrative Timeframe Activities Jan 2010 Estimated Plan Approval from CA Dept of Mental Health Feb-Apr 2010 Engage in Competitive Bidding Process May—July 2010 Contract Negotiations, Board Approval and Awarding of Contracts Aug-Oct 2010 Start up and Staffing of Integrated Mobile Health Teams Nov 1, 2010 1st Quarterly Formative Evaluation and Reporting Design one organizational chart that defines one point of supervision and there is one integrated set of policies and procedures. Establish a baseline of existing funding sources and the number of clients on benefits and projected amount of leveraging required for viability. Nov 2010-Jan 2011 Outreach and Engagement Feb 1, 2011 2nd Quarterly Formative Evaluation and Reporting Confirm that the Integrated Mobile Health Team is as is defined in the organizational chart and the team is following the one set of policies and procedures. Determine that the Integrated Mobile Health Team is actively seeking to maximize leveraging opportunities and is working to establish benefits for new clients. Feb-May 2011 Integrated Mobile Health Team services provided June 1, 2011 3rd Quarterly Formative Evaluation and Reporting Confirm that the Integrated Mobile Health Team’s organizational chart and polices and procedures are effective and make modifications as necessary. Determine if there is an increase in leveraged funding (including benefits establishment). Budget is revised as needed to decrease MHSA revenue utilization as other funding increases. June 2011-Aug 2012 Integrated Mobile Health Team services provided Sept-Dec 2012 Summative Evaluation/Final Report Confirm that any revisions that are made to the organizational chart and the policies and procedures are re-evaluated for effectiveness and if successful, integrated into a best practice model. EXHIBIT C (Page 9 of 11) Innovation Work Plan Narrative Determine if there is a decrease in MHSA revenue utilization as a result of maximizing other leveraging resources. Share results and learnings with various local, state, and national audiences. EXHIBIT C (Page 10 of 11) Innovation Work Plan Narrative Project Measurement Describe how the project will be reviewed and assessed and how the County will include the perspectives of stakeholders in the review and assessment. Current State Desired State Goal Measures Homeless people with physical health, mental health, and substance abuse needs receive fragmented care. Staff who provide physical health, mental health, and substance abuse services, even when “integrated” or “co- located,” work under separate systems, supervisors, regulations, and other requirements. Homeless people with physical health, mental health and substance abuse needs receive integrated services with single point of administrative supervision. Eliminate fragmentation of physical health, mental health, and substance abuse needs for homeless individuals. Review to determine that there is one organizational chart that defines one point of supervision and that there is one integrated set of administrative policies and procedures. Maximize the coordinated use of all funding resources. Funding for physical health, mental health, and substance abuse services comes from discrete and poorly coordinated funding resources and are not fully leveraged. Funding for physical health, mental health, and substance abuse services are braided which will increase the leveraging possibilities Decreased use of MHSA funds and increased use of other State and Federal funding resources, including public benefits. Measure the number, types and amounts of funding sources, as well as their usage, viability and leveraging potential by examining budget and financial statements. EXHIBIT C (Page 11 of 11) Innovation Work Plan Narrative Leveraging Resources (if applicable) Provide a list of resources expected to be leveraged, if applicable. The innovative funding mechanisms imbedded in this project will leverage MHSA dollars in order to reach and serve the greatest possible number of individuals, and they will also encourage the creation of more PSH. MHSA funding will be used to support outreach and engagement and on-going services by the Integrated Mobile Health Team. The team will work toward establishing benefits as quickly as possible to assure leveraging of other funding resources such as FQHC funding, Drug Medi-Cal, and Public/Private Partnership (for uninsured clients). The leveraging of FQHC funds will also be used to serve uninsured clients based on an enhanced reimbursement rate. The innovative project-based service voucher will be used by housing developers to leverage housing capital for the development of more PSH units. The project-based service vouchers will be dedicated to PSH units in a manner similar to how project-based operating subsidies are used to make units affordable for a specific period of time. Developers will apply for project-based service vouchers for a specific number of PSH units dedicated to the MHSA focal population. LAC-DMH will make a commitment to the developer for a specific number of project-based service vouchers. The voucher will indicate that the developer has access to integrated health, mental health, and substance abuse services (among others) through an Integrated Mobile Health Team. Funding will be tied to the housing units, but the level of services would be based on the needs of the clients. In the event the client leaves the PSH project with the project-based service vouchers, the Integrated Mobile Health Team could continue to provide services regardless of the client’s residence using other funding resources. The projected cost of the 3 proposed integrated mobile health teams over 2 years is $8,714,238 (i. e. Year One: $5,220,024; Year Two: $3,494,214). Based on increased numbers of clients obtaining MediCal over the course of the program, the mix of MHSA/leveraged funding will change each year with the MHSA funds decreasing each year. The amount of funding dedicated to two peer/family/parent advocates per team is $240,000 per year. The total number of individuals served through the mobile health team model include individuals receiving outreach, engagement and screening services. Providing these services to individuals may or may not result in individuals becoming engaged in on-going services through the model. EXHIBIT C (Page 1 of 16) Innovation Work Plan Narrative Date: _November 25, 2009___ County: _____Los Angeles County_______________________________________ Work Plan #: __3_______________________________________________________ Work Plan Name: _Community-Designed Integrated Service Management Model_ Purpose of Proposed Innovation Project (check all that apply) INCREASE ACCESS TO UNDERSERVED GROUPS √ INCREASE THE QUALITY OF SERVICES, INCLUDING BETTER OUTCOMES PROMOTE INTERAGENCY COLLABORATION INCREASE ACCESS TO SERVICES Briefly explain the reason for selecting the above purpose(s). While all four of the above purposes apply, the Los Angeles County Department of Mental Health (LAC-DMH) selected “Increase the Quality of Services, including Better Outcomes” as the primary purpose for the entire Innovations Plan through a stakeholder process that determined that its highest priority was to successfully heal the system fragmentation that is a major impediment to service quality and good outcomes. We have developed four models of integration based on an extensive community participation process that generated learning goals and innovative strategies that are salient to the communities and providers in Los Angeles County. All four integration models were specifically designed to encourage community collaboration; to seek integrated service experiences for clients and their families; to focus on wellness, recovery, and resilience; to be culturally competent; and to be driven by consumers, family members, parents, and caregivers. The Community-Designed Integrated Service Management Model (ISM) seeks to increase the quality of services by addressing the fragmentation inherent in the current system of care by building on the strengths of communities, especially underserved ethnic communities. This model envisions a model of care that is defined by the community itself and also promotes collaboration and partnerships between formal and non-traditional service providers, and community-based organizations to integrate physical health, mental health, substance abuse, and other needed care to support the recovery of consumers, with particular attention to underrepresented ethnic populations. In the following project description, “formal” providers are those that are traditionally recognized and funded through public and private insurance. “Non-traditional” providers are individuals who offer community-defined healing practices but do not have credentials that permit reimbursement from public or private insurance. While similar programs may exist, our Community-Designed ISM is innovative for several reasons. First, we are attempting to integrate care in a large, diverse urban environment with complex systems of care. Second, the model differentiates specific needs and approaches for five distinct under-represented ethnic communities. Third, the model focuses on community self-direction for integrated service delivery. Fourth, we EXHIBIT C (Page 2 of 16) Innovation Work Plan Narrative will also integrate peers into the modelʼs mix of formal and non-traditional providers while we integrate physical health, mental health and substance abuse care. EXHIBIT C (Page 3 of 16) Innovation Work Plan Narrative 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 Community-Designed Integrated Service Management (ISM) Model uses a multi-disciplinary, holistic team approach that is determined by the community itself to coordinate and integrate physical health, mental health and substance abuse care. It enhances the resources of the formal network of regulatory providers (e. g. mental health, health, substance abuse, child welfare, and other formal service providers) with culturally-effective principles and values. Services are grounded in ethnic communities with a strong foundation of community-based, non-traditional, and natural support systems such as faith-based organizations, voluntary associations, and other service groups. In this model, ISM teams will integrate formal and informal providers and community-based resources will be integrated through the following: 1) community-designed peer-based outreach and education; 2) community-designed peer-based enhanced engagement practices; 3) community-designed peer-based enhanced linkage and advocacy; and 4) harmonious intertwining of regulatory and non-traditional services and supports through facilitation of inter-provider communication. This ISM Model strives to go beyond other models’ uses of community strengths and partnerships by creating models of care specifically tailored to each of the five under-represented ethnic communities that also integrate health, mental health, and substance abuse services. In this way, there is the identification and differentiation of specific needs and approaches for each of the communities. Also, our approach emphasizes community-defined self-direction for integration of health, mental health and substance abuse services, as well as the interweaving of formal service providers with community-based resources and peers. The ISM model contains discrete teams of specially trained and culturally competent “service integrators” that help clients use the resources of informal and formal networks of regulatory providers (i. e., mental health, health, substance abuse, child welfare, and other formal service providers), and who use culturally-effective principles and values. The ISM Model services are grounded in ethnic communities with a strong foundation of community-based, non-traditional, and natural support systems such as faith-based organizations, voluntary associations, and other service groups. ISM teams will work with each client to ensure service access, coordination, understanding, follow-up, and inter-provider clinical communication. The teams will consist of both service professionals and specially trained peers. These individuals will meet regularly with clients and provide information, transportation, motivation and encouragement, and help with provider communication. ISM team members will consist of professional and life- EXHIBIT C (Page 4 of 16) Innovation Work Plan Narrative experienced consumers (peers), family members, parents, caregivers, cultural brokers and community members, particularly from communities being served. In Los Angeles County, there are five distinct under-represented ethnic populations (UREP) subcommittees representing the mental health needs and concerns of their communities. These subcommittees include: African immigrant/African American (A/AA), American Indian (AI), Asian Pacific Islander (API), Eastern European/Middle Eastern (EE/ME), and Latino. By establishing these five UREP subcommittees as staples in various MHSA planning and stakeholder processes, LAC-DMH created a learning lab for the formal public mental health system to develop culturally competent approaches and services to reach marginalized ethnic communities. This ISM model Innovation Work Plan Narrative has been developed from the collective wisdom of the UREP groups regarding the distinct cultural norms of their communities and how these norms influence mental health needs and service approaches. Each UREP community identified its own unique issues and common themes to address. For example, A/AAs are overrepresented in the mental health system, yet have poor outcomes. Uninsured individuals from the American Indian community receive mental health and substance abuse treatment services that may not be fully compatible with their belief systems and/or culturally-based healing practices. APIs, EE/MEs, and Latinos have experienced limited access to mental health services because services are not provided countywide in their language or within a comfortable cultural context. Many find mental health centers to be stigmatizing and do not trust them as institutions. Formal mental health, physical health, and substance abuse providers have not always recognized nor known how to tap into the inherent resources of ethnic communities and/or they superimpose their own geographic boundaries for service delivery that are incongruent with ethnic communities. This Community-Designed ISM Model seeks to bridge the divide between ethnic communities and formal care providers by giving the communities themselves the opportunity to direct how mental health, physical health, and substance abuse services are integrated into trusted and established institutions of ethnic communities. While the general framework of the model will be consistent throughout the UREP communities, the combined network of care created by each ISM will be different depending on the specific needs and resources identified by the community served. The Community-Designed ISM Model will serve the health, mental health, and substance abuse needs of under-represented ethnic populations who have limited access to culturally-appropriate services. These populations include: 1) families or individuals who have a history of dropping out of services; 2) families or individuals who are linguistically-isolated; 3) families or individuals who have not accessed services due to stigma; and 4) families or individuals who have not benefitted from services or have received inappropriate services. Families are a major focus because typically UREP communities identify family members as one unit and seek services for the whole unit. EXHIBIT C (Page 5 of 16) Innovation Work Plan Narrative For example, a child may be brought in as the “problem,” because it is less stigmatizing to say the child is the problem, when in fact there may be a parent with mental illness. With the ISM Model, the point of entry to services can be through various sites including schools, places of worship, primary care clinics, or other community agencies. Over the course of two years, we propose serving 2,800 highly vulnerable families through this project. FY 10-11 FY 11-12 UREP GROUP GEOGRAPHIC TARGET EST. # OF FAMILIES EST. # OF FAMILIES TOTAL # FAMILIES African/African-American Service Area 6 232 232 464 American Indian Countywide 176 176 352 Asian/Pacific Islander Countywide 320 320 640 Eastern European/Middle Eastern Service Area 2 or 4 120 120 240 Latino 3 Service Areas w/ largest concentration of Latinos and lowest penetration rates 552 552 1,104 This model of integrated care recognizes that community-specific peer-based engagement requires ongoing, multiple contacts with the family. Capacities required of Community-designed ISMs will include an ability to understand, respect, and honor the specific cultures, traditions, and networks of each community. Community-specific peer-based outreach used by the ISM will include methods such as collaboration with community leaders, ethnic media, and informal “word-of-mouth” networks within the community. The community-designed peer-based enhanced service linkage and advocacy will connect families to formal services and community-based services, provide follow-up, and proactively facilitate communication and transportation. The elements of the model and the required capacities of Community-Designed ISMs are detailed in Attachment G. The Community-designed ISM Model supports and is consistent with the General Standards identified in the MHSA and Title 9, CCR, section 3320. The model is grounded in the following specific principles and values: • Clients will receive holistic support that includes integrated physical health, mental health and substance abuse services, as well as other supports such as transportation, follow-up, encouragement, and communication. • All services provided by organizations and staff are culturally and linguistically competent in planning and implementation. Emphasis is placed on the communities of each targeted population providing the information to ensure this. EXHIBIT C (Page 6 of 16) Innovation Work Plan Narrative • ISM programs will use networks or collaboratives that are grounded in their respective communities in the delivery of services and will strive for a horizontal-based association. These collaborative may include grassroots, faith-based organizations, schools, and other entities. • ISM programs will work within and actively strengthen the natural support systems of specific communities, so that these supports can be part of the clients’ recovery process. • ISM programs will rely on clients, family members, parents, and caregivers to inform service providers on what is helpful and needed to assist them toward recovery. • ISM programs will promote the inclusion of consumers (peers), family members, parents and caregivers by training them to provide outreach, engagement, and linkage services. • ISM programs will advocate for changes in the system of care that will better support the integration of services and improved outcomes for the client. • ISM programs will collect and analyze outcome-based data to track and adapt integrated support plans that will strengthen system change. • During the implementation period, the five UREP work groups can provide oversight capacity to ensure that the vision of this innovative model is maintained and proper balance and trust are kept among the participating agencies. • ISM programs will collect and analyze their outcomes to track the cost effectiveness of the services, in particular whether or not the identified focal populations of uninsured, UREP, and homeless are being served in a compassionate and efficient manner. EXHIBIT C (Page 7 of 16) Innovation Work Plan Narrative 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) LAC-DMH is adapting an existing model for application in five distinct, diverse urban communities. The significance of these models of care is that they will illuminate, via outcome measures, the extent to which the model will facilitate culturally informed peer-based services; measure the degree, nature and success of service integration; and provide feedback on which services prove to be the most effective for each ethnic community in developing culturally-competent models of care. 

 . The Community-Designed ISM Model contributes important information and data that will help us understand how best to integrate mental health, physical health, and substance abuse care for diverse ethnic populations. A key innovation of this model is that it allows the communities themselves to leverage their inherent strengths and direct the integration of physical health, mental health and substance abuse services into their existing models of community self-care, rather than having it imposed upon them from outside their communities. Implementation of the Community-Designed ISM can potentially transform the formal mental health system overall by anchoring the integration of mental health, physical health, and substance abuse services in the resources of the diverse UREP communities and through the use of community providers as the starting point for developing a family care plan. In addition, this model can provide important insights into how to lessen the stigma of seeking mental health services and how to deliver culturally competent services. Through our Community Program Planning Process, LAC-DMH and its stakeholders identified the following specific learning questions that would be answered by this model, organized by UREP subcommittee: African/African-American (A/AA): • Is an A/AA-specific integrated service model within the public mental health system able to address multiple needs of A/AAs by providing services in a culturally competent, holistic and cost-effective manner? • Are we able to provide sustainable services over a extended period of time by developing leaders in the A/AA community through training and coordination? • Do we increase the likelihood that A/AA consumers will complete services and sustain increased levels of wellness (thereby reducing their need for intensive services for extended periods of time) through providing a community/holistic service approach? EXHIBIT C (Page 8 of 16) Innovation Work Plan Narrative American Indian: • What DMH policies create barriers in implementing AI mental health/non- traditional healing services? • What mechanism can be developed to address credentialing of, and quality of services provided by AI non-traditional practitioners? • How can AI non-traditional healing be incorporated into a client’s treatment plan so that AI non-traditional practitioners are able to bill for services? • Can identification of AI non-traditional healers and development of a referral system of such individuals lead to cost-effective methods to provide culturally-based recovery services? Asian Pacific Islander: • What kind of program or approach is conducive for APIs to utilize mental health services (i. e. wellness activities, substance abuse counseling) in a way that meets the linguistic diversity and geographic spread of APIs in Los Angeles County? • Can a countywide wellness approach effectively meet the linguistic diversity and geographic spread of API consumers in Los Angeles County? • Can a countywide wellness approach effectively engage grassroots organizations and community groups in a way that is mutually beneficial for both entities? • What kind of wellness activities aid in the recovery process for API consumers? • What kinds of wellness activities satisfy the needs of family members? Eastern European/Middle Eastern: • Can a culturally competent Community-designed one-stop referral and outreach center meet all the physical health, mental health, and substance abuse needs of the Eastern-European/Middle-Eastern communities? • Can this culturally competent, Community-designed one-stop referral and outreach center be replicated to meet the physical health, mental health, and substance abuse needs of other culturally diverse communities? Latino: • Can a culturally competent Community-designed ISM for Latino communities decrease barriers to access for monolingual, underserved, unserved, and inappropriately served Latino communities that are homeless, uninsured/indigent, and/or undocumented? EXHIBIT C (Page 9 of 16) Innovation Work Plan Narrative 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) Implementation/Completion Dates: ____________1/10 – 12/12_______________ MM/YY – MM/YY The proposed system changes in this model are challenging, and the extent of the fragmentation and barriers will not be fully understood until attempted. All integration models have been carefully constructed with a two-year timeframe for reaching LAC¬DMHʼs learning goals and with an eye toward replication if any of the models prove successful. We believe a two-year timeline is sufficient to determine if barriers can be eliminated, fragmentation of services can decrease, and replication is feasible. We expect to learn via outcome measures the extent to which the model will facilitate culturally informed peer-based services; measure the degree, nature and success of service integration; and provide feedback on which services prove to be the most effective for each ethnic community in developing culturally-competent models of care. 

 
 The lessons we learn will be shared with a variety of local, state, and national audiences such as LAC-DMHʼs Systems Leadership Team, MHSA Stakeholder Delegates, MHSOAC, CMHDA, and a variety of public policy forums. The timeline below applies to the Community-designed Integrated Service Management model: Timeframe Activities Jan 2010 Estimated Plan Approval from CA Dept of Mental Health Feb-Apr 2010 Competitive Bidding Process May—July 2010 Contract Negotiations, Board Approval and Awarding of Contracts Aug-Oct 2010 Start up and Staffing of ISM Teams. Monitor and review the number and types of participating community-based partner providers. Nov 1, 2010 1st Quarterly Formative Evaluation and Reporting. Identify, monitor, and address barriers (both internal and external to the Department) to implementation of model and develop a plan to ameliorate barriers. Nov 2010-Jan 2011 Outreach, Engagement, Linkage, Education and Training. Evaluate and explore the essential components leading to successful facilitation of culturally informed peer-based EXHIBIT C (Page 10 of 16) Innovation Work Plan Narrative outreach, engagement, linkage, education and training to ethnic communities. Feb 1, 2011 2nd Quarterly Formative Evaluation and Reporting. Determine and measure the extent to which ISM programs provide service integration management through survey of participating clients, providers and administrators. Feb-May 2011 ISM Services Provided to Families June 1, 2011 3rd Quarterly Formative Evaluation and Reporting Measure the extent to which consumers are completing services (measure rate of recidivism); evaluate how effective non-traditional community-based providers within each ISM have been for each ethnic group; assess if barriers to implementation of model and access to services have been reduced; are the physical, mental and substance abuse needs of the communities being met through the individual models. June 2011-Aug 2012 ISM Services Provided to Families Gather information on the number of non-traditional community-based partners who are providing services to clients. Sept-Dec 2012 Summative Evaluation/Final Report Share results and learnings with various local, state and national audiences. EXHIBIT C (Page 11 of 16) Innovation Work Plan Narrative Project Measurement Describe how the project will be reviewed and assessed and how the County will include the perspectives of stakeholders in the review and assessment. Each UREP ISM has specific outcomes and evaluation measures that are relevant to their individual communities. What follows is a description of the outcomes and evaluation measures for each group as they pertain to the groupʼs previously stated learning questions for the model. African/African-American UREP Outcomes: 1. Creation of community partnerships and collaborations with community based organizations and groups to whom clients were referred; and, 2. Consistent participation in mental health treatment and supportive services to completion. African/African-American ISM Evaluation Measures: 1. Development of partnerships: count of community partners and community- based agencies who referred clients to ISM; and, 2. Consistent participation and completion: a. Consistent Participation means no more than one missed appointment for every four scheduled appointments. b. Completion means that client and ISM teamʼs mutually agreed-upon termination of regular services. American Indian UREP Outcomes: 1. Development of strategies addressing barriers to identifying and credentialing non-traditional practitioners to provide culturally competent quality services; and, 2. Increase the number of consumer referrals to non-traditional practitioners by developing a referral system linking consumers to credentialed healers. American Indian ISM Evaluation Measures: 1. Development of a final report identifying systemic barriers and policies preventing credentialing of non-traditional practitioners. This final report will include: a. Articulation and implementation of strategies to overcome barriers; b. Number of practitioners credentialed; and, c. Number of credentialed practitioners receiving referrals as a result of the project. 2. Increase in consumer referrals to non-traditional practitioners: count of consumer/family referrals linked to non-traditional practitioners through newly EXHIBIT C (Page 12 of 16) Innovation Work Plan Narrative developed referral system for physical health, mental health and substance abuse treatment options. Asian Pacific Islander UREP Outcomes: 1. Increase access for marginalized API ethnic groups that are not currently served or are underserved; 2. Provide cost-efficient and culturally-effective mental health and substance abuse services through partnerships between community-based organizations and public mental health providers; 3. Increase satisfaction from community organizations about working with public mental health providers; 4. Increase family member involvement in the client’s recovery for more sustained periods of time; 5. Increase the number of consumers who become more integrated into their community, find meaningful job opportunities, and learn useful skills or develop new interests; and, 6. Increase the number of consumers, family members, parents, and caregivers who take leadership or instructional roles in the wellness programs. Asian Pacific Islander ISM Evaluation Measures: 1. Increase access for marginalized API ethnic groups that are not served or are currently underserved or inappropriately served. For API families that are not served, underserved or inappropriately served increasing the total number of community-utilized points of entry (e.g., primary care offices, places of worship, schools, etc) and referrals to culturally appropriate and sensitive physical, mental health and substance abuse treatment options; 2. Increased collaborations and partnerships between API community-based organizations and public mental health organizations, measured with a baseline and chart each new partnership; 3. Better recovery rates for the consumer, measured by: a. Tracking the progress of consumers using specific parameters; b. Tracking the satisfaction of family members, parents, and caregivers on the progress of the client; and, c. Setting up parameters to measure various categories like job placement, new skills learned, etc. and monitor this in each client. 4. Higher satisfaction from clients, family members, and collaborative agencies measured through surveys of clients, family members and collaborative agencies to monitor what they feel is successful and what is not. Eastern European/Middle Eastern UREP Outcomes: 1. Increased access to culturally sensitive physical, mental and substance abuse treatment options; EXHIBIT C (Page 13 of 16) Innovation Work Plan Narrative 2. Increased client awareness of mental health issues through culturally appropriate peer-based outreach and education; and, 3. Increased community partnerships between grass roots/cultural organizations and mental health agencies. Eastern European/Middle Eastern ISM Evaluation Measures: 1. Increase access to culturally sensitive physical, mental health and substance abuse treatment options. Measurement of Access: For EE/ME families that are not served, underserved or inappropriately served, increasing the total number of community-utilized points of entry (e.g., primary care offices, places of worship, schools, etc.). 2. Increased EE/ME community awareness of mental health issues, measured through surveys of randomly-selected EE/ME community individuals regarding mental health issues. 3. Creation of community partnerships between service organizations and mental health agencies, measured through a count of agencies that referred clients and agencies to whom clients were referred. Latino UREP Outcomes: 1. Increased access to services for uninsured and/or indigent families served; and, 2. Increased community partnerships between grass roots/cultural organizations and mental health agencies. Latino ISM Evaluation Measures: 1. For Latino families that are unserved, underserved, or inappropriately served, increase the total number of community-utilized points of entry (e.g., primary care offices, places of worship, schools, etc) and referrals to culturally appropriate and sensitive physical, mental health and substance abuse treatment options; and, 2. Creation of community partnerships measured through a count of agencies that referred clients and agencies to which clients were referred. The following chart outlines the measurement goals and measures that apply universally to the model regardless of specific UREP group: Current State Desired State Measurement Goals Measures Relative exclusion of community-based resources Community-based resources are integral service providers Determine the numbers and types of participating community-based partner providers at the beginning of the program over the Measure the number and types of participating community-based partner providers at the beginning of the program over the following 18 months through EXHIBIT C (Page 14 of 16) Innovation Work Plan Narrative following 18 months survey of program clients, providers, and administrators, and larger stakeholder community. No culturally competent service integration capacity to: 1) help clients to access and communicate with a network of formal and non-traditional Mental Health/Substance Abuse/ Health services that are often located in different settings, and 2) support communication and coordination among those service providers. Care is integrated across the network of formal and non-traditional Mental Health/Substance Abuse/ Health services. Determine the extent to which ISM programs provide service integration for formal and non-traditional mental health AND substance abuse AND physical health care services within ethnic communities. Measure the degree, nature, and success of service integration management through survey of program clients, providers, and administrators, and larger stakeholder community. Limited culturally competent outreach and education to UREP communities Culturally-informed peer-based outreach, engagement, linkage, education, and training to UREP communities Determine the extent to which ISM teams facilitate culturally informed peer-based outreach, engagement, linkage, education, and training to their targeted UREP community Increase in the number of formal and non-traditional programs providing integrated and culturally-informed peer-based services Measure the extent to which ISM teams facilitate culturally informed peer-based outreach, engagement, linkage, education, and training to their targeted UREP community through survey of program clients, providers, and administrators, and larger stakeholder community. Assessment by community leaders regarding the linguistic and cultural appropriateness of the peer-based outreach, engagement, linkage, education, and training Regulatory interpretations create barriers to the inclusion of non-traditional healing services Regulatory interpretations facilitate access to services provided by non-traditional practitioners Identify barriers and strategies to address and measure their impact in inhibiting access to nontraditional services Develop and measure the Measure the degree to which non-traditional practitioners are integrated into mental health, health and substance abuse treatment through survey of program clients, providers, EXHIBIT C (Page 15 of 16) Innovation Work Plan Narrative effectiveness of methodologies to facilitate non-traditional practitioners to accept referrals from a newly developed referral system and administrators, and larger stakeholder community. EXHIBIT C (Page 16 of 16) Innovation Work Plan Narrative Leveraging Resources (if applicable) Provide a list of resources expected to be leveraged, if applicable. In this model, LAC-DMH is leveraging the inherent resources of Los Angelesʼ diverse communities such as established trust and relationships with ethnic communities and intimate knowledge of culturally-relevant approaches to a familiesʼ physical health, mental health and substance abuse care. We envision that these resources include, but are not limited to, the following: • Free or reduced rent for community space; • 12-Step recovery groups; • Volunteers from faith-based, cultural, and community groups; • Mentorship programs; • Community resources such as Boys and Girls Clubs, food banks, clothing barns, etc.; and, • Free or reduced ancillary care such as Planned Parenthood or free health clinics. The total amount of MHSA INN funding required for the ISM model is 15,997,800 over two years of initial INN funding. This estimate provides funding for five distinct ISMs for each of the five UREP groups, including African/African-American, ($2,652,770), American Indian ($2,010,158), Asian/Pacific Islander ($3,647,740), Eastern European/ Middle Eastern ($1,370,246) and Latino ($6,316,886). The amounts proposed for each UREP group are based on a weighted compilation of (1) poverty population (40%) ; (2) prevalence rates (30%) ; and (3) penetration rates (30%). In an effort to address stigma within ethnic communities and include community members in serving consumers, funding for this model will also be used for outreach, engagement and education activities through ISMs for each ethnic population. The total number served through the ISM model will include individuals receiving outreach, engagement, education and screening services. Provision of these services to individuals may or may not result in on-going services through the model. 
 
 EXHIBIT C (Page 1 of 11) Innovation Work Plan Narrative Date: _November 25, 2009__ County: _____Los Angeles County_______________________________________ Work Plan #: ___4___________________________________ ___________________ Work Plan Name: _Integrated Peer-Run Model ______________________________ Purpose of Proposed Innovation Project (check all that apply) INCREASE ACCESS TO UNDERSERVED GROUPS √ INCREASE THE QUALITY OF SERVICES, INCLUDING BETTER OUTCOMES PROMOTE INTERAGENCY COLLABORATION INCREASE ACCESS TO SERVICES Briefly explain the reason for selecting the above purpose(s). While all four of the above purposes apply, the Los Angeles County Department of Mental Health (LAC-DMH) selected “Increase the Quality of Services, including Better Outcomes” as the primary purpose for the entire Innovations Plan through a stakeholder process that determined that its highest priority was to successfully heal the system fragmentation that is a major impediment to service quality and good outcomes. We have developed four models of integration based on an extensive community participation process that generated learning goals and innovative strategies that are salient to the communities and providers in Los Angeles County. All four integration models were specifically designed to encourage community collaboration; to seek integrated service experiences for clients and their families; to focus on wellness, recovery, and resilience; to be culturally competent; and to be driven by consumers, family members, parents, and caregivers. The Integrated Peer-Run Model seeks to increase the quality of care and services for the uninsured who may also be homeless and/or members of under-represented ethnic populations (UREP) by using a peer-driven model to identify, obtain, and coordinate mental health, physical health, and substance abuse care, thus reducing the fragmentation inherent in the current system of care. Two distinct strategies for peer support are imbedded in this model, and they offer a broader range of peer-run options for the public mental health system. While other examples of peer-run models exist, this Integrated Peer-Run Model is innovative in important respects. First it combines two service strategies—Peer Run Integrated Services Management (PRISM) and peer-run crisis houses– to expand the potential of peer-run services and apply them to Los Angeles’ large and complex urban environment. Second, the Peer-Run Integrated Services Management (PRISM) utilizes peer support to address physical health, mental health and substance abuse issues across systems in a more integrated and coordinated way, and the peer-run crisis houses involve a creative team work approach to stabilization and community linkeage to a spectrum of services.. Together, these service strategies expand the possibilities for peer staffing, including administration and supervision by peers and are designed to EXHIBIT C (Page 2 of 11) Innovation Work Plan Narrative be utilized by peers from diverse cultures, including traditionally underserved communities. EXHIBIT C (Page 3 of 11) Innovation Work Plan Narrative 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 Integrated Peer-Run Model supports people with mental health needs who also have health and/or substance abuse issues to become well and stay well by providing new programs that are designed and run by people with lived experience of mental health issues. This consumer-led, Integrated Peer-Run Model also has the capacity to effectively coordinate other forms of peer supports for the consumers’ family members, parents, children, and caregivers. Other peers such as Family Specialists, Parent Partners, and Caregivers are able to help the consumers’ family members, parents, and caregivers through critically important peer-to-peer relationships. This model incorporates two innovative strategies: Peer-Run Integrated Services Management (PRISM) and Alternative Peer-Run Crisis Houses. PRISM is a client-driven, holistic alternative to formal public mental health services that allows uninsured peers to secure needed physical health, mental health, and substance abuse options as part of a program designed to support and empower people to take responsibility for their own recovery. PRISM utilizes a “whatever it takes” philosophy in a context of personal choice. It is innovative in that it is a team approach that involves peers helping peers. Alternative Peer-Run Crisis Houses are client-driven, holistic alternatives to hospitalization and are designed to provide a warm, safe, welcoming environment for uninsured people in psychiatric distress who are not a danger to others. These houses will be located in two places in separate service areas, and one of them will be dedicated to providing peer support to people in crisis who are being released from jail. Together, these strategies expand the range of peer-run options within the public mental health system. In both strategies, people in recovery from mental health, physical health, and/or substance abuse issues will develop reciprocal relationships with uninsured people like themselves who are dealing with similar issues and who may be in crisis or dealing with trauma. Both strategies are culturally competent in that the adults involved will be supported by peers who are similar to them linguistically and ethnically, and by peers who respect and value cultural differences. There are two differences between Alternative Peer-Run Crisis Houses and PRISM. The Alternative Peer-Run Crisis Houses are intended to provide safe and healing environments where people can move through their psychiatric distress in a relatively brief time (up to 15 days) and then engage in further services if desired, which might include referral to the PRISM team. PRISM will help consumers find housing (including collaborative housing if preferred), volunteer opportunities, and jobs in the community. EXHIBIT C (Page 4 of 11) Innovation Work Plan Narrative In addition to the problems associated with the fragmentation of services, people experiencing a mental health crisis — whether insured or uninsured — lack alternatives to institutional and more costly options such as hospitals and urgent care centers. The Peer-Run Alternative Crisis House provides a cost-effective alternative within the public mental health system to provide support to people experiencing a mental health crisis. The public mental health system has not effectively and fully integrated peer-run programs into the array of public mental health services and supports for uninsured people with mental health issues. In this regard, the proposed Integrated Peer-Run Model can help ascertain the extent to which peer-run strategies result in effective coordination of care, high-quality care, and increased cost effectiveness. The peer-run strategies are designed to serve uninsured adults with a mental health issue seeking support (PRISM) and uninsured adults with a mental health issue experiencing a crisis (Alternative Peer-Run Crisis Houses). The uninsured adults must also have either a physical health or substance abuse issue; and they also may be members of UREP and/or homeless. We anticipate that approximately 300 individuals will receive services annually through PRISM and 216 individuals will receive services annually through the Alternative Peer-Run Crisis Houses. PRISM and the Alternative Peer-Run Crisis Houses possess similar elements. Both will be staffed by teams including but not limited to Peer Administrators/Managers, Peer Supervisors, and Peer Specialists (including Family Specialists and Parent Partners). “Team” refers to a set of peers who work in a coordinated fashion in order to achieve a common goal: to effectively integrate mental health, physical health, substance abuse, and other services in order to support people in their personal journey toward recovery. “Team” does not presuppose that all team members are supervised by the same person. Creative modes of coordination and accountability are encouraged, such as sub-contracting with other peer-run programs as the need arises. Team members conduct outreach and engagement activities to a broad range of entities to ensure multiple points of entry for uninsured persons, including but not limited to county jails, emergency departments, faith-based communities, family groups, parent groups, peer-run programs, self-help groups, and urgent care centers. Staff in both strategies must be sufficiently diverse and skilled to provide peer support to the following: 1) uninsured adults with mental health, physical health, substance abuse issues who may also be homeless; 2) uninsured adults who may be from UREP communities; 3) uninsured adults from Gay/Lesbian/Bisexual/Transgender/Questioning/ Intersex, Deaf or Hard-of-Hearing, and Blind or Visually-Impaired communities; and 4) family members, parents, and caregivers with children who may be uninsured and themselves wanting support. In addition, programs will demonstrate the following capacities: 1) ability to sustain trusting reciprocal relationships with peers; 2) capacity to link to and secure desired services within time constraints; 3) willingness to advocate for peers, including advocating to obtain free services and/or appropriate assessments for individuals seeking professional services; 4) experience in ways to enhance health, EXHIBIT C (Page 5 of 11) Innovation Work Plan Narrative including but not limited to preparing nutritious food and participating in appropriate exercise; 5) demonstrated knowledge of and linkage to self-help services; 6) openness to spiritual beliefs and practices; and 7) experience with supervising peers. A detailed description of the Integrated Peer-Run Model is provided as Attachment H. The Integrated Peer-Run Model supports and is consistent with the General Standards identified in the MHSA and Title 9, CCR, section 3320. The model is grounded in the following specific principles and values: • Peer specialists in a peer-run model will be responsible for designing and administering programs and securing services. • Safety concerns will be addressed in both training and supervision of the peer specialists who work in this model. • The peer-run model is consumer-driven and focused on developing trusting relationships with peers that support and enhance recovery. • The systems-level transformation will be the successful integration of mental health, physical health, and substance abuse interventions within the context of a peer-run model that is both creative and cost effective. EXHIBIT C (Page 6 of 11) Innovation Work Plan Narrative 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) The Integrated Peer-Run Model brings three important innovations to peer-run strategies in the context of the Los Angeles County public mental health system. The first is the use of an Integrated Service Management (ISM) team approach to peer-run strategies. The ISM team that is supervised, administered, and implemented by peers for the coordination of mental health, physical health, and substance abuse services is new. Second, the model combines two peer-run strategies, PRISM and the Alternative Peer-Run Crisis Houses, to work in tandem to offer consumers a broader array of peer-run supports. The third type of innovation is the integration of multiple forms of peer supports. The Integrated Peer-Run Model seeks to effectively coordinate and deliver different types of peer supports in the consumers’ recovery. Peer support can come from consumers in recovery, parents, family members, and caregivers. This model utilizes peer support to coordinate physical health, substance abuse, and mental health care across systems in an integrated way. During our Community Program Planning Process, LAC-DMH and its stakeholders identified the following specific learning question that would be answered by this model: • Can peer-run strategies result in effective coordination of health, mental health, and substance abuse services, including self-help modalities, while supporting recovery and wellness and increasing cost effectiveness? In addition, the Integrated Peer-Run Model will allow us to develop answers for the following learning questions: • Will a peer-run crisis house, as an alternative to hospitalization, prove effective in reducing psychiatric distress quickly and safely in a complex urban environment? • Will the expansion of possibilities for peer staffing, including administration and supervision by peers, demonstrate a creative model for addressing physical health, substance abuse, and mental health issues across systems in a coordinated way? EXHIBIT C (Page 7 of 11) Innovation Work Plan Narrative 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) Implementation/Completion Dates: ____________1/10 – 12/12_______________ MM/YY – MM/YY The system changes proposed in these four integration models are challenging, and the extent of the fragmentation and barriers will not be fully understood until attempted. All integration models have been carefully constructed with a two-year timeframe for reaching LAC-DMH’s learning goals and with an eye toward replication if any of the models prove successful. We believe a two-year timeline is sufficient to determine if barriers can be eliminated, fragmentation of services decrease, and replication is feasible. Because of the “learn-as-we-go” nature of this project, quarterly progress reports will allow adjustments to be made quickly as needed. The lessons we learn will be shared with a variety of local, state, and national audiences such as LAC-DMH’s Systems Leadership Team, MHSA Stakeholder Delegates, MHSOAC, CMHDA, and a variety of public policy forums. The timeline below applies generally to our overall Innovations Plan: Timeframe Activities Jan 2010 Estimated Plan Approval from CA Dept of Mental Health Feb – Apr 2010 Competitive Bidding Process May – July 2010 Contract Negotiations, Board Approval and Awarding of Contracts Aug – Oct 2010 Start up and Staffing of Peer-Run Models Training of culturally diverse staff in resources, including multiple self-help peer-run resources, team building, reporting methods and safety issues with input from mental health professionals and consultants to this model Nov 1, 2010 1st Quarterly Formative Evaluation and Reporting Presentation of training materials and report on methods for addressing any barriers to developing links to integrating health, mental health and substance abuse services Nov 2010 – Jan 2011 Outreach and Engagement Provision of training and consultation on jail linkages as well as community engagement with ongoing feedback to PRISM and the EXHIBIT C (Page 8 of 11) Innovation Work Plan Narrative crisis houses on outcomes Feb 1, 2011 2nd Quarterly Formative Evaluation and Reporting Report on outcome measures Summary of challenges and successes with regard to creative use of peer specialists (people in recovery, family members, parent partners) in integrating health, mental health and substance abuse services in a culturally competent manner Feb – May 2011 Integrated Peer-Run Services Provided Adjustments to strategies as needed with ongoing training and consultation on scope of peer support and cultural competency with ongoing feedback to PRISM and the crisis houses on outcomes June 1, 2011 3rd Quarterly Formative Evaluation and Reporting Report on outcome measures and use of peer specialists as team members, including any supervisory or administrative issues that have been addressed and resolved in addressing crises and integrating health, mental health and substance abuse services June 2011 – Aug 2012 Integrated Peer-Run Services Provided Adjustment to strategies as needed with ongoing training and consultation on scope of peer support and cultural competency as well as ongoing feedback to PRISM and the crisis houses on outcomes Sept – Dec 2012 Summative Evaluation/Final Report Report on Outcome measures Summary of challenges and successes with regard to staffing, supervision and administration peer-run crisis houses as an alternative to hospitalization and PRISM as a client-driven peer-run approach to the integration of health, mental health and substance abuse services Share results and learnings with various local, state and national audiences. EXHIBIT C (Page 9 of 11) Innovation Work Plan Narrative Project Measurement Describe how the project will be reviewed and assessed and how the County will include the perspectives of stakeholders in the review and assessment. Current State Desired State Goals Measures Mental Health / Physical Health/ Substance Abuse services coordinated by peers is non-existent. Peers coordinate the provision of integrated services for mental health AND physical health AND Substance abuse services, including self-help. Determine the extent to which peer-run strategies can coordinate integrated health, mental health and substance abuse services with self help. The number of clients who are successfully referred to health services and substance abuse services as well as other community supports. No collaborative structure that enables the coordination of multiple forms of peer supports. Peer-run strategy will coordinate multiple peer-run supports and self-help programs. Determine the extent to which peer-run strategies will increase access to and the use of peer-run and self-help programs and will increase client quality of life. Survey number of peer-run and self- help programs used by service recipients Clinically Informed Outcome Measure (CIOM) – to measure client perception of increased quality of life. Survey program participants and their family members, if available, to access satisfaction with services received. Lack of alternatives to more institutional and costly options such as hospitals and urgent care Peer-Run Programs provide cost-effective alternatives to consumers in crisis. Determine the extent to which peer-run crisis house is an effective alternative to higher levels of The number of clients served by the peer-run model who do not present at a psychiatric emergency room, EXHIBIT C (Page 10 of 11) Innovation Work Plan Narrative centers care such as urgent care centers and hospitals. psychiatric inpatient facility or jail within 2 months of assistance at the PRISM or peer-run crisis house. Compare the cost of crisis house services with the cost of higher levels of care if peer-run crisis house is not utilized EXHIBIT C (Page 11 of 11) Innovation Work Plan Narrative Leveraging Resources (if applicable) Provide a list of resources expected to be leveraged, if applicable. In this model, LAC-DMH is leveraging the inherent resources of the peer-based support networks within Los Angeles. We envision these resources in include, but are not limited to, the following: • Donated or volunteered professional services (provided in-kind); • Free or reduced rent for community space; and, • Free or low-cost food, clothing, and access to other needed programs. The annual cost of PRISM (serving an estimated 300 consumers annually) will be $1,460,000, or a total cost of $2,920,000 for two years. The Alternative Peer-Run Crisis House (serving an estimated 216 consumers annually) will cost $975,000 per year, or a total cost of $1,950,000 for two years. EXHIBIT D Innovation Work Plan Description (For Posting on DMH Website) County Name Los Angeles Work Plan Name Overarching Concept to Innovation Plan Annual Number of Clients to Be Served (If Applicable) 4,416 Total Population to Be Served (if applicable): The LAC-DMH Innovations Plan is proposing four innovative models to serve individuals and families who are uninsured, homeless and from under-represented ethnic populations with mental health, physical health and/or substance abuse problems. Project Description (suggested length – one-half page): Provide a concise overall description of the proposed Innovation. All models address the problem of fragmentation of health, mental health and substance abuse services and seek to learn how to improve the quality of services and achieve better outcomes for individuals with significant mental illness who are uninsured, homeless and from underrepresented ethnic populations (UREP). Model I – Integrated Clinic Model combines physical health, mental health and substance abuse services in community-based sites, such as primary care or mental health clinics, to better address the spectrum of needs of the target population. This strategy seeks to improve access to the aforementioned services to those for whom services are fragmented and resources limited. (Estimated 1,600 to be served annually) Model 2 – Mobile Health Team seeks to increase the quality of services for individuals with a diagnosis of mental illness and their families who are homeless or have recently moved into permanent supportive housing. This model proposes to use a mobile, enhanced, integrated, multidisciplinary team managed under one agency. It will leverage multiple funding sources including Federal Qualified Health Center (FQHC) funding and capital for housing development. (Estimated 900 to be served annually) Model 3 – Community Designed Integrated Service Management (ISM) will build on the strengths of UREP communities by integrating community-based and non-traditional services with more formal clinical services to improve quality of care to UREP families. It will include community defined outreach, engagement, education, linkage and advocacy. (Estimated 1,400 to be served annually) Model 4 – Peer-Run Model will support a Peer-Run ISM to coodinate and deliver integrated clinical and self help mental health, physical health and substance abuse services (estimated 300 to be served annually) and a Peer-Run Crisis House as an alternative to higher levels and more costly crisis services (estimated 216 to be served annually). All models include peers in their strategies. EXHIBIT D Innovation Work Plan Description (For Posting on DMH Website) County Name Los Angeles Work Plan Name Integrated Clinic Model Annual Number of Clients to Be Served (If Applicable) 1,600 Total Population to Be Served (if applicable): Target populations will include uninsured and/or homeless, and /or members of UREP. Individuals served will be eligible for specialty mental health services and could benefit from primary health care and/or substance abuse treatment services. Data from Los Angeles County, WRMA Sacramento, and the California State Department of Mental Health indicate an estimated population with Serious Emotional Problems (SEP) and Serious Mental Illness (SMI) at 706,388 individuals in Los Angeles County. Of these, 326,913 individuals live below 200% of the federal poverty level according to its 2008 report. The target populations may be selected based on the density of uninsured, homeless and/or UREP, utilization patterns, and other available data. Project Description (suggested length – one-half page): Provide a concise overall description of the proposed Innovation. The Integrated Clinic model seeks to increase the quality of care and services for the uninsured, including those who are homeless and/or members of under-represented ethnic populations (UREP) by reducing the fragmentation inherent in the current system of care. This model will support the capacity of primary care or mental health clinics to integrate on-site mental health, physical health, and substance abuse treatment services in an effective, culturally-relevant, and consumer-driven manner for individuals with significant mental illness who are homeless, uninsured, and/or members of UREP. In this way, the model provides a “home” for people seeking integrated care. The Integrated Clinic Model uses a multi-disciplinary team approach to address the client as a whole avoiding the silos, duplication, and fragmentation inherent in the current system of care; leverages an existing untapped framework of community-based providers with the potential to offer a spectrum of community-driven and client-focused primary care, mental health, and substance abuse services; emphasizes the whole person approach to health services, including critical enabling services (e. g. transportation, linguistic support, care management, etc.) which are the hallmark of the community-based care; ensures culturally and linguistically competent care through a model designed to provide accessible, affordable, culturally appropriate and non-discriminatory care to the underserved; and, works to reduce the myriad barriers to care for under-represented populations. While other efforts to integrate care exist, our Integrated Clinic Model is innovative for several reasons. First, we are attempting to integrate care in a large, complex urban environment and in a system that includes directly operated and contracted entities. Second, the model specifically targets the most vulnerable populations to test whether integrated care improves service quality to them. Third, for those primary care sites integrating on-site mental health and substance abuse treatment services, this model extends the definition and scope of the mental health care to support and treat serious mental illness within the borders of a primary care site. Fourth, for those mental health sites that will imbed physical health and substance abuse services, the model’s innovation includes the opportunity to stabilize the client enough to determine whether he or she can change the health home to a physical health site with support (e.g. moving the client to a wellness center or to a primarily physical health site as a move along the continuum of care). Lastly, this Integrated Clinic Model’s use of peers as staff is unique even among existing co-sited model design and systems of care. EXHIBIT D Innovation Work Plan Description (For Posting on DMH Website) County Name Los Angeles Work Plan Name Integrated Mobile Health Team Annual Number of Clients to Be Served (If Applicable) 900 Total Population to Be Served (if applicable): Individuals/Families with a diagnosis of mental illness who are homeless including but not limited to those living on the streets and in shelters or those who have recently moved into PSH from homelessness. Some will be the most vulnerable individuals as defined by the Common Ground Vulnerability Index or other methods based on community priorities. a.Individuals/Families who have multiple disabling conditions and are living on the street b. Indiv/Families with multiple disabling conditions, living in shelters/transit. housing c. Formerly homeless indiv/families who have multiple disabling conditions living in PSH. Project Description (suggested length – one-half page): Provide a concise overall description of the proposed Innovation. The Integrated Mobile Health Team Model is a client-centered, housing-first approach that uses harm reduction strategies across all modalities of mental health, physical health, and substance abuse treatment. In this model, the primary goal is to address the fragmentation of services to the homeless population, many of whom are uninsured and are members of UREP. This model proposes to deploy a mobile, enhanced, integrated, multi-disciplinary team that includes physical health, mental health, and substance abuse professionals and specially-trained peers and that is managed under one agency or under one point of supervision. This model will develop individualized client care plans that contains physical health, mental health, and substance abuse client-centered treatment goals and objectives. Individuals will have access to the Integrated Mobile Health Team services through multiple points of entry, whether initially seeking assistance with physical health, mental health, substance abuse, or housing. It will increase access to services and leverage multiple funding sources including capital for housing development and Federal Qualified Health Center funding. While other mobile team models exist, our Integrated Mobile Health Team model is innovative for several reasons. First, we are attempting to integrate care in a complex urban environment that is geographically widespread and maintain those services even after individuals move into permanent supportive housing. Second, the Integrated Mobile Health Team will be managed under one agency or under one point of supervision, which is unusual in Los Angeles’ complex system of multiple departments and agencies. Third, it will increase access to services and leverage multiple funding sources including Federal Qualified Health Center (FQHC) funding and capital for housing development which have not previously been tapped. EXHIBIT D Innovation Work Plan Description (For Posting on DMH Website) County Name Los Angeles Work Plan Name Community-Designed Integrated Service Management Model Annual Number of Clients to Be Served (If Applicable) 1,400 Total Population to Be Served (if applicable): The Community-Designed ISM is designed to serve the health, mental health, and substance abuse needs of under-represented ethnic populations that have limited access to culturally-appropriate services and/or will be potentially displaced from services due to funding gaps. In addition, these populations include: 1. Families/individuals who have a history of dropping out of services; 2. Linguistically-isolated individuals/families; 3. Families that have not accessed services due to stigma; and, 4. Families that have not benefitted from services or have received inappropriate services. The Los Angeles County Department of Mental Health (LAC-DMH) is committed to working alongside ethnic and cultural communities that have been historically on the periphery of the mental health system. These communities, referred to as UREP (Under-Represented Ethnic Populations), provide LAC-DMH with a wealth of resources and information on how to best serve currently unserved, underserved, and inappropriately served ethnic populations with the goal of bettering their mental health outcomes and overall well being. In Los Angeles County, there are five distinct UREP subcommittees representing the mental health needs and concerns of their communities. These include African Immigrant/African American (A/AA), American Indian (AI), Asian Pacific Islander (API), Eastern European/Middle Eastern (EE/ME) and Latino. Project Description (suggested length – one-half page): Provide a concise overall description of the proposed Innovation. The Community-Designed Integrated Service Management Model (Community-Designed ISM) addresses the fragmentation inherent in the current system of care by building on the strengths of a community, especially underserved ethnic communities. Collaboration and partnerships between regulated entities, contract providers and community-based organizations will integrate health, mental health, substance abuse, and other needed care to support the recovery of consumers, with particular attention to under-represented ethnic populations. With the ISM model, the point of entry to services will be through various sites including schools, places of worship, primary care clinics, or other community agencies. The Community-Designed ISM model: 1) uses a multi¬disciplinary, integrated service management team consisting of professional and life-experienced consumers, family members, parents, caregivers, cultural brokers and community members, particularly from communities being served; 2) draws upon the resources from a network of regulatory providers (i. e., mental health, health, substance abuse, child welfare, and other formal service providers) working with a foundation of community-based, non-traditional, and natural support systems; 3) coordinates the integration of the regulatory providers and community-based resources through: (a) Community Specific Outreach and Education; (b) Community Specific Enhanced Engagement practices; (c) Enhanced Linkage and Advocacy (d) Harmonious Intertwining of Regulatory and Non-Traditional Services and Supports; 4) Culturally-effective principles and values and, 5) Reduction of identified barriers to service delivery for under-represented populations. While similar programs may exist, our Community-Designed ISM model is innovative for several reasons. First, we are attempting to integrate care in a large, diverse urban environment with complex systems of care. Second, the model differentiates specific needs and approaches for five distinct under-represented ethnic communities. Third, the model focuses on community self-direction for integrated service delivery. Fourth, we will also integrate peers into the model’s mix of formal and non-traditional providers while we integrate physical health, mental health and substance abuse care. EXHIBIT D Innovation Work Plan Description (For Posting on DMH Website) County Name Los Angeles Work Plan Name Integrated Peer-Run Model Annual Number of Clients to Be Served (If Applicable) 516 Total Population to Be Served (if applicable): 1. Uninsured adults with a mental health issue seeking support 2. Uninsured adults with a mental health issue experiencing a crisis 3. Sub-Populations Uninsured with mental health, health, substance abuse issues (may be homeless), Uninsured from UREP communities; Uninsured GLBTQI, Deaf or Hard-of-Hearing, Blind, Visually Impaired communities; Family members, parents/caregivers with children Project Description (suggested length – one-half page): Provide a concise overall description of the proposed Innovation. The Integrated Peer-Run Model supports people with mental health needs who also have additional health and/or substance abuse treatment needs to become well and stay well by providing new programs that are designed and run by people with lived experience of mental health issues. This model incorporates two innovative strategies: Peer-Run Integrated Services Management (PRISM) (estimated 300 to be served annually) and Alternative Peer-Run Crisis Houses (estimated 216 served annually). PRISM is a client-driven, holistic alternative to traditional community mental health services that allows uninsured peers to secure needed physical health, mental health, and substance abuse options as part of a program designed to support and empower people to take responsibility for their own recovery. PRISM is based upon a “whatever it takes” philosophy in a context of personal choice. It consists of innovative, specially-trained peer teams that share features of ISM teams in the Community-Designed ISM Model. As in the ISM model, the teams work with peers to ensure service access, coordination, understanding, follow-up, and communication. Also as with ISM teams, PRISM teams will meet regularly with peers and provide information, transportation, motivation and encouragement, and help with provider communication. However, unlike the teams in the ISM model, PRISM teams will consist entirely of specially-trained peers who will coordinate the provision of clinical services and coordinate and deliver peer-run/self help services. Peer-Run Crisis Houses are client-driven, holistic alternatives to hospitalization and are designed to provide warm, safe, welcoming environments for uninsured people in psychiatric distress who are not a danger to others. These houses will be located in two sites/ service areas, and one of them will be dedicated to providing peer support to people in crisis who are being released from jail. Together, these strategies expand the range of peer-run options in the public mental health system. While other examples of peer-run models exist, this Integrated Peer-Run Model’ is innovative in important respects. First, it combines two service strategies — Peer Run Integrated Services Management (PRISM) and peer-run crisis houses — to expand the potential of peer-run services and apply them to Los Angeles’ large and complex urban environment. Second, the Peer-Run Integrated Services Management (PRISM) utilizes peer support to address physical health, mental health and substance abuse issues across systems in a more integrated and coordinated way, and the peer-run crisis houses involve a creative team work approach to stabilization and community linkage to a spectrum of services. Together, these service strategies expand the possibilities for peer staffing, including administration and supervision by peers and are designed to be utilized by peers from diverse cultures, including traditionally underserved communities. COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH MENTAL HEALTH SERVICES ACT (MHSA) MHSA Innovation Plan (Exhibits E and F) MHSA Innovation (INN) Plan Overview of the Budget and Budget Narrative The following pages contain the LACDMH Innovation Plan Budget and Budget Narratives. The planning and development process for the budget involved a review and analysis of current programs that contain similar elements that served as a template regarding each model. The next step included multiple consultations with community mental health contract providers, internal program heads and other program professionals that could provide input regarding the establishment of estimates for the number of clients served per model. When reviewing the LACDMH Innovation Plan Budget, the following concepts apply: The primary goal of the Innovation Plan is to use the broadest most nonspecific outline for budgeted services to be provided in these conceptualized four models LACDMH hopes to maintain the highest level of flexibility in reviewing proposed budgets and plans for leveraging within proposals submitted by agencies during the competitive bidding process Flexibility will allow agencies the opportunity to submit proposals that are truly creative and innovative All subsections including Personnel Expenditures, Operating Expenditures and Revenues are all meant to be estimates based on anticipated expenses and macro assumptions regarding revenue. EXHIBIT E Mental Health Services Act Innovation Funding Request Los Angeles Date: Innovation Work Plans Estimated Funds by Age Group (if applicable) No. Children, Youth, Families Transition Age Youth Adult Older Adult 1 3,640,000 2 5,220,024 3 7,998,900 3.1 African/African‐American ISM $1,326,385 3.2 American Indian ISM $1,005,079 3.3 Asian/Pacific Islander ISM $1,823,870 3.4 Eastern European/ Middle Eastern ISM ISM $685,123 3.5 Latino ISM $3,158,443 4 2,435,000 4.1 PRISM $1,460,000 4.2 Alternative Crisis House $975,000 5 19 20 26 $19,293,924 $0 $0 $0 $0 27 $1,000,000 28 29 $20,293,924 $0 $20,293,924.00 Funds from Approved/Received CPP Dollars Total Request for INN Funding Total MHSA Funds Required for Innovation Plus Optional 10% Operating Reserve Subtotal: Work Plans Plus County Administration Name Integrated Clinic Model Mobile Health Team Model Community Designed Integrated Service Model (ISM) FY 09/10 Required MHSA Funding 11/25/2009 Peer-Run Model County: EXHIBIT F County: Los Angeles 2009/10 Work Plan #: 1 Work Plan Name: Integrated Clinics Model New Work Plan Expansion Months of Operation: 1/10-12/12 MM/YY – MM/YY County Mental Health Department Other Governmental Agencies Community Mental Health Contract Providers Total 2,040,000 $2,040,000 1,760,000 $1,760,000 $0 $0 200,000 $200,000 $0 $0 $4,000,000 $4,000,000 $0 360,000 $360,000 $0 $0 $0 $0 $360,000 $360,000 $0 $0 $360,000 $360,000 $0 $0 $3,640,000 $3,640,000 Prepared by: 11/24/2009 Telephone Number: 3. Total New Revenue 4. Total Revenues 2. Additional Revenues a. Federal Financial Participation Ansara J. Lewis Date: C. Total Funding Requirements c. (insert source of revenue) B. Revenues 1. Existing Revenues Innovation Projected Revenues and Expenditures 213 251-6836 1. Personnel Expenditures 4. Training Consultant Contracts 5. Work Plan Management6 ota oposed o a Expenditures 2. Operating Expenditures 3. Non-recurring expenditures b. (insert source of revenue) A. Expenditures Fiscal Year: COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH MENTAL HEALTH SERVICES ACT MHSA Innovation (INN) Plan Budget Narrative: Integrated Clinics Model A. EXPENDITURES Personnel Expenditures: Salaries and benefits for estimated FTEs including costs associated with personnel for data collection, evaluation and reporting Operating Expenditures: Estimated costs associated with the day-to-day operations of the project/plan. Includes building or office rent/lease, utilities, supplies, insurance or fees, travel and/or transportation, on-going medication and/or medical supplies, perishable furnishings (such as pillow cases, towels, masks etc.), ongoing costs such as food or like supplies, mileage, expenses for travel, and client supportive services. Work Plan Management: Estimated cost for Community Mental Health Contract Providers to provide sufficient oversight and internal management of their contracted project. This includes the responsibility to provide requested data, outcomes, and reports B. REVENUES Federal Financial Participant: Estimated possible revenue from FFP. Estimates are based on data secured from current programs with similar elements to this model EXHIBIT F County: Los Angeles 2009/10 Work Plan #: 2 Work Plan Name: Mobile Health Team Model New Work Plan Expansion Months of Operation: 01/10-12/12 MM/YY – MM/YY County Mental Health Department Other Governmental Agencies Community Mental Health Contract Providers Total 3,640,830 $3,640,830 2,310,000 $2,310,000 300,000 $300,000 0 $0 0 $0 $0 $0 $6,250,830 $6,250,830 $0 852,246 $852,246 178,560 $178,560 $0 $0 $0 $1,030,806 $1,030,806 $0 $0 $1,030,806 $1,030,806 $0 $0 $5,220,024 $5,220,024 Prepared by: 11/24/2009 Telephone Number: 3. Total New Revenue 4. Total Revenues 2. Additional Revenues a. Federal Financial Participation Ansara Lewis Date: C. Total Funding Requirements c. (insert source of revenue) B. Revenues 1. Existing Revenues Innovation Projected Revenues and Expenditures 213 251-6836 1. Personnel Expenditures 4. Training Consultant Contracts 5. Work Plan Management6 ota oposed o a Expenditures 2. Operating Expenditures 3. Non-recurring expenditures b. Federal Qualified Health Center A. Expenditures Fiscal Year: COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH MENTAL HEALTH SERVICES ACT MHSA Innovation Plan Budget Narrative: Mobile Health Team Model A. EXPENDITURES Personnel Expenditures: Salaries and benefits for estimated FTEs including costs associated with personnel for data collection, evaluation and reporting Operating Expenditures: Estimated costs associated with the day-to-day operations of the project/plan. Includes building or office rent/lease, utilities, supplies, insurance or fees, travel and/or transportation, on-going medication and/or medical supplies, perishable furnishings (such as pillow cases, towels, masks etc.), ongoing costs such as food or like supplies, mileage, expenses for travel, and client supportive services and Fixed Assets such as a possible vehicle. Non-recurring Expenditures: Estimated One time cost. Items including fixed assets such as vehicles, office equipment, computers, desks, chairs and communication devices such as phones etc for base location. B. REVENUES Federal Financial Participant: Estimated possible revenue from FFP. Estimates are based on data secured from current programs with similar elements to this model Federal Qualified Health Center: Estimated revenue from FQHC EXHIBIT F County: Los Angeles 2009/10 Work Plan #: 3 Work Plan Name: Community Designed Integrated Services Model (ISM) New Work Plan Expansion Months of Operation: 1/10-12/12 MM/YY – MM/YY County Mental Health Department Other Governmental Agencies Community Mental Health Contract Providers Total 4,639,000 $4,639,000 2,639,999 $2,639,999 319,956 $319,956 0 $0 399,945 $399,945 $0 $0 $7,998,900 $7,998,900 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $7,998,900 $7,998,900 Prepared by: 11/24/2009 Telephone Number: 3. Total New Revenue 4. Total Revenues 2. Additional Revenues a. (insert source of revenue) Ansara Lewis/Tara Yaralian Date: C. Total Funding Requirements c. (insert source of revenue) B. Revenues 1. Existing Revenues Innovation Projected Revenues and Expenditures 213 251-6836 / 251-6814 1. Personnel Expenditures 4. Training Consultant Contracts 5. Work Plan Management6 ota oposed o a Expenditures 2. Operating Expenditures 3. Non-recurring expenditures b. (insert source of revenue) A. Expenditures Fiscal Year: COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH MENTAL HEALTH SERVICES ACT MHSA Innovation Plan Budget Narrative: Community Designed Integrated Services Management (ISM) Model A. EXPENDITURES Personnel Expenditures: Salaries and benefits for estimated FTEs including costs associated with personnel for data collection, evaluation and reporting Operating Expenditures: Estimated costs associated with the day-to-day operations of the project/plan. Includes building or office rent/lease, utilities, supplies, insurance or fees, travel and/or transportation, on-going medication and/or medical supplies, perishable furnishings (such as pillow cases, towels, masks etc.), ongoing costs such as food or like supplies, mileage, expenses for travel, and client supportive services to purchase non-traditional and other supports that are specific to each ethnic group model Non-recurring Expenditures: One time cost. Items including fixed assets such as vehicle, office equipment, computers, desks, and communication devices such as phones Work Plan Management: Estimated cost for Community Mental Health Contract Providers to provide sufficient oversight and internal management of their contracted project. This includes the responsibility to provide requested data, outcomes, and reports EXHIBIT F County: Los Angeles 2009/10 Work Plan #: 4 Work Plan Name: Peer-Run Model New Work Plan Expansion Months of Operation: 1/10-12/12 MM/YY – MM/YY County Mental Health Department Other Governmental Agencies Community Mental Health Contract Providers Total 1,208,200 $1,208,200 556,500 $556,500 111,450 $111,450 437,100 $437,100 121,750 $121,750 $0 $0 $2,435,000 $2,435,000 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $2,435,000 $2,435,000 Prepared by: 11/24/2009 Telephone Number: 3. Total New Revenue 4. Total Revenues 2. Additional Revenues a. (insert source of revenue) Ansara J. Lewis Date: C. Total Funding Requirements c. (insert source of revenue) B. Revenues 1. Existing Revenues Innovation Projected Revenues and Expenditures 213 251-6836 1. Personnel Expenditures 4. Training Consultant Contracts 5. Work Plan Management6 ota oposed o a Expenditures 2. Operating Expenditures 3. Non-recurring expenditures b. (insert source of revenue) A. Expenditures Fiscal Year: COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH MENTAL HEALTH SERVICES ACT MHSA Innovation Plan Budget Narrative: Peer Run A. EXPENDITURES Personnel Expenditures: Salaries and benefits for estimated FTEs including costs associated with personnel for data collection, evaluation and reporting Operating Expenditures: Estimated costs associated with the day-to-day operations of the project/plan. Includes building or office rent/lease, utilities, supplies, insurance or fees, travel and/or transportation, on-going medication and/or medical supplies, perishable furnishings (such as pillow cases, towels, masks etc.), ongoing costs such as food or like supplies, mileage, expenses for administrative costs, travel, and peer client supportive services for health, mental health and SA Non-recurring Expenditures One time cost for two houses. Items include office equipment, computers, desks, printer/copier and communication devices such as phones, and fax machines Training Consultant Contracts Consultation and Training with local, national and statewide experts Work Plan Management: Estimated cost for Community Mental Health Contract Providers to provide sufficient oversight and internal management of their contracted project. This includes the responsibility to provide requested data, outcomes, and reports Attachment A MHSA INNOVATIONS (INN) PLAN: COORDINATION DIAGRAM COORDINATOR: GLADYS LEE PROJECT MANAGER: DARLESH HORN AD HOC #3: UREPAD HOC #2: UNINSURED‐ INDIGENTS AD HOC #1: HOMELESS EMT: Kathleen Daly, MD Community: Elizabeth Boyce, LAC‐DHS Dept. Lead: Maria Funk, Ph. D District Chief EMT: Roderick Shaner, MD Community: Jim Preis, Delegate/SLT Dept Lead: Paula Packwood Plans from previous processes and new ideas. Plans from previous processes and new ideas. Plans from previous processes and new ideas. Priority INTEGRATION TEAM Co‐Chairs: Jim Preis and Dr. Shaner • Identify opportunities for integration • Craft an integrated plan • Propose funding structure • Recommend evaluation strategy • Selected 9 Reps from Population EMT: Olivia Celis & Carlotta Childs‐Seagle Community: Ed Viramontes Latino UREP Co‐Chair Dept Lead: Tara Yaralian Program(s) APPROVAL PROCESS ‐LA Stakeholder Delegates ‐LACDMH Director Priority Program(s) Workgroups Recommended unty n ‐LAC MH Commission ‐LAC Board of Supervisor ‐State DMH Los Angeles Co Innovations Pla 80 Priority Program(s) Uninsured Review existing strategies Review new strategies UREP Review existing strategies Review new strategies Homeless Review existing strategies Review new strategies Asian Pacific Islander Prepare strategies Engage UREP Committees Eastern European/Middle Eastern Prepare strategies Engage UREP Committees American Indian Prepare strategies Engage UREP Committees Latino Prepare strategies Engage UREP Committees African/African‐American Prepare strategies Engage UREP Committees Integration Review Team 10 existing members (Integration Team) 9 new members (Focal Population Workgroup Representatives) Select Practice Models and Strategies UREP Groups Recommend up to 5 strategies Select up to 3 representatives (criteria: consumer and/or family member, provider, or cultural broker) for Integration Review Team Recommend up to 5 strategies Select up to 3 representatives (criteria: consumer and/or family member, provider, or cultural broker) for Integration Review Team Recommend up to 5 strategies Select up to 3 representatives (criteria: consumer and/or family member, provider, or cultural broker) for Integration Review Team Provide input to draft selection criteria Ensure principles are met: uninsured, integration of health, mental health, and substance abuse, and transformation Prioritize strategies Recommend funding allocation Public Submissions Integration Review Team Tasks Focal Population Workgroup Tasks Focal Population Workgroup Tasks Focal Population Workgroup Tasks Focal Population Workgroups 81 ATTCH B-MHSA INN Strategy Submission Log COUNTY OF LOS ANGELES–DEPARTMENT OF MENTAL HEALTH MHSA-INNOVATIONS (INN) STRATEGIES SUBMISSION LOG SEPTEMBER 25, 2009 Strategy Submitter Homeless Uninsured UREP ID# AAA Centered Faith-Based and Holistic Services Project AAA UREP x 01 AAA Neighborhood Family Enrichment Project AAA UREP x x x 02 ACE Study-Based System of Primary Medical Care, Supportive Services, and Health Education Peggy Edwards x x 03 Advocacy to Increase Ease/Flexibility of attempting employment for persons with disabilities AFSCME x x x 04 Alano Clubs – Supportive Services Co-located x x x 05 Brief Cognitive Behavioral Therapy for Homeless Women with Post-Traumatic Stress Disorder: Training and Feasibility for LACDMH USC School of Social Work x x x 06 Building a best practices model to serve adults with dual diagnosis: a partnership with the Tierra del Sol Foundation Tierra del Sol Foundation x x x 07 Cell Phones/Radios for the Homeless Roland Moses x x x 08 Child Development Center for Parenting and School Readiness x 09 Community Relations, Education and Outreach (CREO) Mental Health America of Los Angeles x x 10 Consumer and Family James Randall x 11 Core Gift Coorporation with Sol Adventurers Foundation Stars, Inc x x 12 Cross-Sector Collaborative Project Black Los Angeles County Client Coalition (BLACCC) x x x 13 Dedication to Education Street Team Mentor Program Inner City Industry (ICI) x x x 14 Developing an Evidenced Based Practice for Ethnic Psychotic Elders Heritage Clinic x x 15 DPSS/DMH Collaboration to Transition GR NSAs to SSI DPSS x x x 16 Dr Floyd McGregor’s Chill Out CBT Anger Management Program CONNECTING – it works! Inc x x 17 Early Intervention First Break TAY Choices Recovery Services x x x 18 Eat & Meet Life Skills Program Peggy Edwards x 19 Embedding Health Care to Engage High Risk Homeless Individuals Mental Health America of Los Angeles x x 20 Family Empowerment for Families with Special Needs Children Jeffrey Foundation x 21 Field Based FSP Services Utilizing a Full-Sized Van Choices Recovery Services x x x 22 FSP Diversion Pilot Project Mental Health America of Los Angeles x x 23 Health Integration Project Pacific Clinics x 24 HIP-Harmonious Integration Plan API UREP x 25 Hope and Home Foothill Family Service x x x 26 Housing Centered Income Maximization Project for homeless mentally disabled individuals x x x 27 Integrated Care for Consumers with Co-Occurring Disorders Tarzana Treatment Centers x x x 28 page 1 of 4 82 ATTCH B-MHSA INN Strategy Submission Log COUNTY OF LOS ANGELES–DEPARTMENT OF MENTAL HEALTH MHSA-INNOVATIONS (INN) STRATEGIES SUBMISSION LOG SEPTEMBER 25, 2009 Strategy Submitter Homeless Uninsured UREP ID# Integrated Dual Disorder Treatment Quality and Access Improvement Don Parrington x x x 29 Integrated Healthcare, Mental Health, SA Services to Homeless Mentally Ill SF Valley Community Mental Health Center x x x 30 Integrated Primary and Behavioral Healthcare for Mental Health Consumers Didi Hirsch Mental Health Services x x x 31 Integrated School Health Center Mandy Johnson x x 32 Integrated Supportive Housing Management Mollie Lowery x x 33 Integrating Behavioral Health into the Medical Home Community Clinic Association of LA x x x 34 Integrating Mental Health into Perinatal Care: Addressing Depression in Pregnancy and the Postpartum Children’s Health Outreach x x 35 Integrating Mental Health Screening, Referral and Brief Treatment into Primary Care Tarzana Treatment Centers x x x 36 Just In Reach Eimago/Union Rescue Mission x 37 Korean Family Health Project Asian American Drug Program x 38 Latino Family Access Centers DMH-Ana Suarez/Sam Chan x x 39 LGBT Aging In Place Initiative LA Gay & Lesbian Center x x 40 Life Source Life Source x x x 41 Life Works LA Gay & Lesbian Center x x x 42 Long Beach TAY Collaborative Long Beach TAY Collaborative x x x 43 Low Barrier Drop In Center for Homeless TAY Step up on Second x x x 44 Marketing Fiscal Sources for DMH programs to School Officials Community Family Guidance Center x x x 45 Mary Lind COD Integration Strategy Mary Lind Recovery Centers x x x 46 Medication-Assisted Therapy with Vivitrol for Alcohol Dependent, Trauma-Exposed COD Individuals Tarzana Treatment Centers x x x 47 Mental Health and Integrated Care Management of Uninsured in public sector utilizing Medical Services Organization Paula Packwood x x x 48 Mental Health Prevention in Emergency Department Setting Tarzana Treatment Centers x x x 49 Mental Health’s Sustentacularability Strategy Plan (MHSSP) Rev. James Steele x x x 50 MHSA Innovations Countywide Fun for Services in Permanent Supportive Housing Shelter Partnership x 51 Mobile Brief Responsive Counseling Didi Hirsch Mental Health Services x x x 52 Multidisciplinary And Integrated Mobile Health Team Peggy Edwards x x 53 Multidisciplinary Mobile Team for Chronically Homeless in Hollywood Saban Free Clinic x 54 Multi-Family Group DMH-James Randall x 55 Older Adult UREP Peer Support Project DMH-Older Adult Programs Admin x 56 Ourtreach, Linkage and Education-OLE Latino UREP x 57 Para Los Ninos Mental Health Collaborative Care Model Para Los Ninos x x x 58 page 2 of 4 83 ATTCH B-MHSA INN Strategy Submission Log COUNTY OF LOS ANGELES–DEPARTMENT OF MENTAL HEALTH MHSA-INNOVATIONS (INN) STRATEGIES SUBMISSION LOG SEPTEMBER 25, 2009 Strategy Submitter Homeless Uninsured UREP ID# Parents and Child Care Providers Working Together for the Future Child Care Resource Center (CCRC) x x x 59 Peer Recovery Collaboration x x x 60 Peer-Run Respite House Project Return x x 61 Pilot Integrating Health, Mental Health and Supportive Services to Head Start Families Kedren Community Health Center x x 62 Primary Care-Based Telepsychiatry DMH-Older Adult Programs Admin x x 63 Project to Access and Sustain Permanent Housing (PAS) Mollie Lowery x x 64 Project-Based Service Vouchers (PBSV) Skid Row Housing Trust x x x 65 Promoting Mental Health through Healthy Relationship Skills California Healthy Marriages Coalition x x 66 PROTOTYPES Center for Innovation and Integration Prototypes x x x 67 Reach Out to At-Risk, Trauma Exposed Families Armenian Relief Society of West USA x x x 68 Recovery After Initial Schizophrenia Episode (RAISE) Program DMH-James Randall x 69 Regenerative Transitional Behavior Therapy (RTBT-T) Diane McNeal x x x 70 Outreach and Referral Center for Multicultural Mental Health Services EE/ME UREP x x x 71 Responding to Domestic Violence: The “Whole Person” Approach Children’s Institute x x 72 Salud Y Familia Media Campaign LA Child Guidance Clinic x 73 School Based Mental Health and Substance Abuse Prevention Tarzana Treatment Centers x x 74 Secure Attachment for Family Engagement (SAFE) Vista Del Mar Child and Family Services x x 75 Seeking substance abuse treatment for individuals receiving Section 8 housing AFSCME x x 76 Sober Living House – Supportive MH Services x x x 77 SPA 6 Restoration Center (S6RC) Special Service for Groups x x x 78 Steps to Success Laurel Bear, Rosalie Finer-Alliant Int. x x x 79 Stop LGBTQ Family Violence LA Gay & Lesbian Center x x x 80 Strength Through Access and Resources (STAR) Family Service x x 81 System Development: Mental Health, Substance Abuse, and Health Program LBHI x 82 Teachers and Life Coaches (TLC) Antelope Valley Partners for Health x x x 83 The Restoring Urban Traditional Healing (RUTH) Project AI UREP x x x 84 The SHARE Program SCHARP x x x 85 The Three R’s – Building Relationships, Resiliency & Recovery LA Child Guidance Clinic x 86 Therese Haviland’s CBT Langauge Arts Therapy Therese Haviland x 87 Trauma Informed Afterschool Program for Middle School Students Didi Hirsch Mental Health Services x x 88 Trauma Systems Therapy for Substance Abusing Adolescents and Transitional Age Youth Children’s Institute x x x 89 Understanding and Addressing Homelessness in the Context of Trauma Children’s Hospital x 90 page 3 of 4 84 ATTCH B-MHSA INN Strategy Submission Log COUNTY OF LOS ANGELES–DEPARTMENT OF MENTAL HEALTH MHSA-INNOVATIONS (INN) STRATEGIES SUBMISSION LOG SEPTEMBER 25, 2009 Strategy Submitter Homeless Uninsured UREP ID# Video Conference Technology Field based Psychiatric Services Choices Recovery Services x x x 91 Volunteer Companions Step up on Second x x x 92 Vulnerability Index Full Service Partnership Initiative x 93 Vulnerable Veterans Initiative Peggy Edwards x 94 Web Based Interactive Behavioral Modification and Treatment Intervention Institute for Multicultural Counseling & Education Services, Inc x x x 95 Wellness on Wheels Children’s Institute x x x 96 WIN Services for Families Outside the Network Westside Infant Family Network x x x 97 Youth Outreach Trailer to deliver PEI Mental Health Services Choices Recovery Services x x x 98 Advancing the Transition to Adulthood Among Older Youth and Young Adults with MH Needs and Fragile Community Connectedness (Advancing Pathways to Success) Kathy Millet x x x 99 Hire Staff to Assist Under-Age (less than 60) Hoarders DMH – EAD x x x 100 Peer-Run Crisis Residential Program DMH – EAD x x x 101 Procovery DMH – EAD x x x 102 Peer Support Strategies For Consumers DMH – EAD x x x 103 Collaborative Care Strategy for Consumers DMH – EAD x x x 104 Provide Support for People with Mental Health Problems Ruth Hollman x x x 105 page 4 of 4 85 COUNTY OF LOS ANGELES— DEPARTMENT OF MENTAL HEALTH MHSA INNOVATIONS PLAN Identifying Critical Question, Integration Models and Innovative Strategies Critical question to be answered by Los Angeles County INN Plan: What are the most effective models for integrating Mental Health, Physical Health, and Substance Abuse services in our defined focal populations of Uninsured, Homeless, and Under-represented ethnic populations? Innovative Strategies 1. Integrate health and substance abuse services in mental health setting. 2. Integrated services in primary care setting. Innovative Strategies 1. Peer Bridgers Brokering Integrated Services 2. Peer support for successful transition from jail into the community 3. Peer/family crisis alternative services Cross-Cutting Innovative Strategies (can be integrated in one or more models): 1. Peer Bridgers brokering integrated services. 2. Wellness Promoters integrating health, mental health and substance abuse. 3. Tele-psychiatry Innovative Strategies 1. Enhanced and integrated mobile teams. 2. Project-based service vouchers 3. Integrated team mobile services. Innovative Strategies 1. Neighborhood Family Enrichment Project 2. Referral System for Traditional Healers 3. Countywide Approach to Provide a Wellness Program 4. Culturally-Competent Community-Defined Outreach and Referral Services Center 5. Outreach, Linkage, and Education Collaborative All models will integrate mental health, health and substance abuse services. Model 1: Integrated Clinic Model Model 2: Integrated Mobile Health Team Model 3: Community-Designed Integrated Service Management Model Model 4: Integrated Peer-Run Model ATTACHMENT C 86 COUNTY
OF
LOS
ANGELES—
DEPARTMENT
OF
MENTAL
HEALTH
 MHSA
INNOVATIONS
PLAN
 Identifying Learning Goals, Critical Question, and Integration Models 
 Critical question to be answered by Los Angeles County INN Plan: What are the most effective models for integrating Mental Health, Physical Health, and Substance Abuse services in our defined focal populations of Uninsured, Homeless, and Under-represented ethnic populations? 
 Learning Goals 
 
 
 
 
 
 Area Two Leveraging Financial Resources and Sustainability Learning Goal: Can the integration of mental health, physical health, and substance abuse treatment services generate a structure that leverages funding streams and results in sustainable, integrated and multi-disciplinary care that meets the multiple needs of people with mental health disabilities? Area Four High Quality and Cost- Effective Peer-Run Models Learning Goal: Can peer-run strategies result in effective coordination of health, mental health, and substance abuse services including self-help modalities, while supporting, recovery and wellness and increasing cost-effectiveness? 
 Area One System Integration of Mental Health, Health and Substance Abuse Learning Goal: Can a multi-disciplinary model of fully integrated health, mental health, and substance abuse services be embedded within the public mental health system that results in the accurate identification and appropriate treatment of poly-occurring health, mental health and substance abuse disorders? Area Three Community-Defined, Culturally Competent Model of Care with Underrepresented Ethnic Populations Learning Goal: Can ethnic community resources be engaged and utilized to increase access and improve the quality of mental health services for consumers from UREP communities? 
 Innovative Strategies (15)
 Model
1:







 Integrated
Clinic

 Model
 Model
3:


 Community‐Designed
 Integrated
Service
 Management
Model

 Model
2:

 Integrated
Mobile
 Health
Team
 Model
4:

 Integrated
Peer‐Run
 Model
 ATTACHMENT E Innovations Plan – Detailed Description of Integrated Clinic Model County of Los Angeles – Department of Mental Health I. Vision The Integrated Clinic model seeks to increase the quality of care and services for the uninsured, including those who are homeless and/or members of under-represented ethnic populations (UREP) by reducing the fragmentation inherent in the current system of care. This model will support the capacity of primary care or mental health clinics to integrate on-site mental health, physical health, and substance abuse treatment services in an effective, culturally-relevant, and consumer-driven manner for individuals who are homeless, uninsured, and/or members of UREP. In this way, the model provides a “home” for people seeking integrated care. The Integrated Clinic Model: 1. Uses a multi-disciplinary team approach to address the client as a whole avoiding the silos, duplication, and fragmentation inherent in the current system of care; 2. Leverages an existing untapped framework of community-based providers with the potential to offer a spectrum of community-driven and client-focused primary care, mental health, and substance abuse services; 3. Emphasizes the whole person approach to health services, including critical enabling services (e. g. transportation, linguistic support, care management, etc.) which are the hallmark of the community-based care; 4. Ensures culturally and linguistically competent care through a model designed to provide accessible, affordable, culturally appropriate and non-discriminatory care to the underserved; and, 5. Works to reduce the myriad barriers to care for under-represented populations. II. Innovations While other efforts to integrate care exist, our Integrated Clinic Model is innovative for several reasons. First, we are attempting to integrate care in a large, complex urban environment and in a system that includes directly operated and contracted entities. Second, the model specifically targets the most vulnerable populations to test whether integrated care improves service quality to them. Third, for those primary care sites integrating on-site mental health and substance abuse treatment services, this model extends the definition and scope of the mental health care to support and treat serious mental illness within the borders of a primary care site. Fourth, for those mental health sites that will imbed physical health and substance abuse services, the model’s innovation includes the opportunity to stabilize the client enough to determine whether he or she can change the health home to a physical health site with support (e.g. moving the client to a wellness center or to a primarily physical health site as a move along the continuum of care). Lastly, this Integrated Clinic Model’s use of peers as staff is unique even among existing co-sited model design and systems of care. III. Target Population ATTACHMENT E Innovations Plan – Detailed Description of Integrated Clinic Model County of Los Angeles – Department of Mental Health Target populations will include uninsured and/or homeless, and /or members of UREP. Individuals served will be eligible for specialty mental health services and could benefit from primary health care and/or substance abuse treatment services. Data from Los Angeles County, WRMA Sacramento, and the California State Department of Mental Health indicate an estimated population with Serious Emotional Problems (SEP) and Serious Mental Illness (SMI) at 706,388 individuals in Los Angeles County. Of these, 326,913 individuals live below 200% of the federal poverty level according to its 2008 report. The target populations may be selected based on the density of uninsured, homeless and/or UREP, utilization patterns, and other available data. IV. Need Addressed As documented in the September 2009 Integration Policy Initiative report by the California Institute of Mental Health and the Integrated Behavioral Health Project, “The failure to address the need for primary and behavioral health care coordination and integration has resulted in grave consequences for individuals and families including chronic medical conditions and early mortality in individuals with serious mental illnesses. The other side of the primary care/behavioral health interface is the significant number of people in primary care that need behavioral health services. Primary care is usually the first health care contact for individuals and is intended to provide comprehensive care. Integrating care at these sites will improve access while eliminating the stigma often experienced while seeking care at mental health only sites. Recently published studies indicating that persons with serious mental illness in the United States can expect to live an average of 25 fewer years than the general population, have underscored the pressing need to improve and facilitate access to coordinated and integrated physical and mental health care and services. The ability to detect and treat mental health or substance use issues in the primary care setting and to screen for and even treat the identified need for physical health services in the mental health setting may improve the quality of care received from both systems of care in facilitating treatment of the whole individual. The potential for increased quality of care and service and improved clinical outcomes is inherent in an integrated care model. Using a common care plan and noting clinical findings, medications and treatments in a common medical record increases the providers’ capacities to recognize, treat and refer clients more appropriately and comprehensively. Safer care and improved individual client outcomes will be the benefits of providers understanding of the whole spectrum of health issues affecting a client, including medications, plan of care, etc. The timeliness of the “warm handoff” technique as well as the embedded systems of care will strengthen the drive toward efficiency and patient-centered care. V. Program Elements, Process and Services Element Set 1: Service Provider Management Team ATTACHMENT E Innovations Plan – Detailed Description of Integrated Clinic Model County of Los Angeles – Department of Mental Health 1. The service provider management team will be responsible for the following: a. Identifying a lead Project Director to coordinate operations; b. Verifying licensure for the delivery of mental health, physical health and substance abuse services; c. Billing third party payer sources for mental health, physical health and substance abuse services; d. Establishing and meeting pre-defined systems-focused and client- centered outcomes, for each client and for the program overall; and, e. Accessing INN funding allocated for service provision by Integrated Clinic Model 2. Capacities: a. Train staff/others who will be screening clients and providing referrals; b. Establish and document appropriate clinical and community network for referral and supportive services; and, c. Track clients through a database and use an electronic integrated care plan. Element Set 2: Staffing, Services Provided and Administrative Structure 1. Staffing a. Integrative Care will be provided by an on-site care team with multi- disciplinary staff. The on-site care team works to facilitate communication among service providers to ensure that the range of services available is identified and shared systematically among the team. Staff must include, at a minimum, licensed providers for mental health, physical health, and substance abuse, and skilled care coordinators/case managers, peer staff, and benefits establishment counselors. The onsite care team may also include the following staff members: • Primary care physician; • Psychiatrist; • Depression care manager; • Licensed Clinical Social Worker; • Nurse Practitioner; • Certified Substance Abuse Counselor; • Clerical Support; • Billing Clerk; and, • Promotores or other ethnic support or peer counselors. 2. Services Provided a. This model brings together at one site systems with a common interest in providing care to the uninsured and medically indigent, restructuring the health care and mental health delivery system around an integrated and ATTACHMENT E Innovations Plan – Detailed Description of Integrated Clinic Model County of Los Angeles – Department of Mental Health expanded network of public and private providers combining resources to improve the mental health and physical health outcomes of the underserved. This includes potential for peer involvement assisting clients with other services such as transportation, case management, linguistic support, and case management. The Integrated Clinic Model would provide services to an estimated 1,600 individuals over the course of a year at four planned clinic sites (400 individuals/year each). At a minimum, required on site services would include: specialty level mental health care, physical health care, and substance abuse treatment services with referrals for other specialty services. Other services available on site may include the following: • Pharmacy-Prescriptions and medications (dispensary) will be available on site; • Ancillary-Lab work would be drawn at site; • Non- traditional sources, social services and hospital linkages; • On-site benefit establishment including DPSS staff or linkage; • Individuals requiring highly specialized services not available in the integrated clinic can be appropriately linked to necessary programs. The referral network must be defined and documented; and, • Remote services provided onsite, which may include integration of tele-psychiatry and/or tele-medicine. 3. Administrative Structure a. Supervision of Care team -On site care team may come from different agencies, but must deliver integrated care under the management of the project director. b. Team process will include regular case conferencing, regularly updated unified care plan and follow up, and periodic re-evaluation of diagnosis and medication. c. Access, outreach and availability-Individuals could receive services at the clinic through referrals or as a walk in at a center that provides mental health, physical health and substance abuse care. d. Data availability and assessment-Data based referrals 4. Capacities a. Location at a geographically appropriate site for convenient service delivery to the identified target population, as identified by available data sources b. Demonstrated linkage capacity, including information transfer, to mental health, specialty physical health, substance abuse, non-traditional services, and social services providers in the communities that serve the target population ATTACHMENT E Innovations Plan – Detailed Description of Integrated Clinic Model County of Los Angeles – Department of Mental Health c. Cultural Competence: Clinic and agencies to which they refer clients must provide accessible, affordable, culturally-appropriate and non-discriminatory services to low-income families; d. Ability to track and report on services and linkages e. Screening tool will be used at the integrated care clinic as well as the referring agencies, it must be robust enough to determine acuity level and document basis of dollars used for other than mental health services Element Set 3: Client Flow The Integrated Clinic Model utilizes the “no wrong door’ approach to services, meaning that clients can access the full suite of services by engaging a provider in any of the three disciplines. At the core of the Integrated Clinic Model is the “warm hand-off’ approach. For example, a patient enters a community clinic for a primary care appointment and establishes a medical home. During the encounter with the patient, the primary care physician conducts a simple mental health screening. Finding symptoms of a potential mental health condition, the physician can then call on the clinic’s mental health consultant to come to the exam room. Utilizing evidence-based assessment techniques and tools, the mental health provider then links the patient to the appropriate level of intervention matching the intensity of need. In another variation of the integration model where primary healthcare is embedded at a mental health site, screening and a warm hand-off approach is also utilized with the mental health provider performing the screening and hand-off to a physical health provider at the mental health clinic. 1. Critical components a. Tracking of clients will be done through a database. Database (to track client information from DMH and DHS or primary care provider); b. Care coordinators/Case managers assist clients through the service structure as well as tracking clients through the system; c. Case conferencing (would include on-site and off-site service providers); d. Electronic integrated care plan that is standardized for all would help collect data for outcome; and, e. Possible development and implementation of an Encounter Data Sheet. 2. Funding and Leveraging of Resources a. Leveraging with FQHC and Public Private Partnership (PPP) funding for uninsured mental and physical health care with substance abuse funding and MHSA for mental health care as indicated under Innovations project plan funding; and, b. Also leverage with third party payer funding for greater percentage of clients as they work with the benefits establishment coordinator. VI. Principles and Values ATTACHMENT E Innovations Plan – Detailed Description of Integrated Clinic Model County of Los Angeles – Department of Mental Health The integrated clinic model supports and is consistent with the General Standards identified in the MHSA and Title 9, CCR section 3320. The model is grounded in the following specific principles and values: 1. Client Centered Care and service; 2. Prospective care planning and facilitation as well as coordination; 3. Provider to provider communication; 4. Pre established network for clinical, non traditional or CBO referral; 5. Peers included in teams; 6. Timeliness; 7. Safety; 8. Data driven outcomes both systemic and client centered; 9. Efficiency while quality oriented; 10. Cultural competence’ 11. Improvement in access to care at appropriate level of care and service; and, 12. Wellness Focus: Providers will offer coordinated services with a focus on wellness in all disciplines. Additionally, the model utilizes trusted community resources and non-traditional mental health settings. Integrating mental health services into the primary care setting can reduce the stigma associated with traditional mental health settings. Integrating physical services into mental health settings will increase access of clients with serious mental illness into physical health care. VII. Outcomes and Contribution to Learning 1. Service level and system change outcomes: a. clinician satisfaction survey; b. medication usage; c. screening tool usage; d. referral process adherence; e. tracking and data adherence to process and data and reporting compliance; f. follow up for chronic illness treatment and for mental illness protocols; g. timeliness and access standards compliance; and, h. use of unified electronic patient care plan with frequent scheduled team conferencing and update. 2. Transformative learning questions -Global questions; a. Can an integrated structure for mental, physical and substance abuse care decrease fragmentation and improve timeliness and efficiency in the system as evidenced by the following: 1) improved clinical outcomes; 2) improved utilization patterns with decrease in emergency room usage and inappropriate or frequent hospitalizations; and 3) improved timeliness of access to all of these systems of care ATTACHMENT E Innovations Plan – Detailed Description of Integrated Clinic Model County of Los Angeles – Department of Mental Health b. Can an integrated system of care increase the capacity of the system to track care and outcomes and embark on a continuous quality improvement process between and among systems of care as evidenced by the following: 1) data systems available to support tracking of project participants, utilization patterns across systems and patient outcomes; and 2) structure for assessment of barriers and to support CQI c. Can provider levels of competency around appropriate referrals to mental health or physical health care be demonstratively improved by training and coaching on the referral protocol established by the model 3. Transformative Learning Questions – Los Angeles County specific. a. Through our Community Program Planning Process, LACDMH and its stakeholders identified the following specific learning questions that would be answered by this model: b. Can Los Angeles County expand and better coordinate services in order to improve health outcomes and better utilize limited public resources?Can the capacity of the public mental health system be expanded to serve uninsured persons with high acuity levels? c. Can integrated mental health and substance abuse services be provided at primary care settings? d. Can integrated physical health and substance abuse services be provided at mental health settings? e. How will persons of differing acuity levels access these integrated mental health and substance abuse services? f. Will the imbedding of services at primary care settings decrease the stigma of clients receiving mental health services? g. Will these persons achieve positive outcomes? h. Can these services be delivered in a cost-effective way? 4. Client level outcomes a. patient satisfaction surveys b. medical and psychiatric clinical measures of improvement c. utilization patterns pre and post at appropriate level of care d. compliance with treatment goals and strategies VIII. Project Measurement Current State Desired State Goals Measures Mental Health / Physical Health/ Substance Abuse services located in different settings resulting in Single sites provide integrated services for mental health AND physical health AND Substance Determine the extent to which each program site provides mental health AND physical health AND substance abuse Survey of program clients, providers, and administrators, and larger stakeholder ATTACHMENT E Innovations Plan – Detailed Description of Integrated Clinic Model County of Los Angeles – Department of Mental Health fragmented care. abuse services. services. community. Mental Health care & Physical care are located at different sites resulting in diminished access for clients with Mental Illness. Integrated Care at common site to improve access and create more efficiency in the patient/person centered system. Determine the extent to which every program provides common site for mental health, physical health and substance abuse care and services. Survey of program clients, providers, and administrators, and larger stakeholder community. Current programs often have a lack capacity for communication coordination and sharing of information. Clinical, operational and other pertinent information is available to all on-site providers involved in patient’s care in a timely manner and supports prospective care planning and safety. Determine the extent to which each program changes or eliminates barriers to information sharing Identification and inventory of barriers as baseline and determination of the degree of change or elimination of identified barriers through survey of program clients, providers, and administrators, and larger stakeholder community. Many current programs lack capacity to fully integrate other community-based resources Community-based resources are integral service providers. Determine the extent to which each program increases the types and numbers of community-based partnerships and peer-provided services associated with integrated care sites. Measure the number of community-based partnerships and peer-provided services at selected program sites at the beginning of the program and at 18 months. Client must often go to multiple sites to receive care needed. Clients can receive necessary care at one site Determine the extent to which each program integrates and provides health, mental health, and substance abuse Survey of program clients, providers, and administrators, and larger stakeholder community. ATTACHMENT E Innovations Plan – Detailed Description of Integrated Clinic Model County of Los Angeles – Department of Mental Health services at one site. Funding for integrated mental health, physical health and substance abuse programs is often difficult to sustain. Funding for integrated mental health, physical health and substance abuse programs is ongoing. Identify mechanisms for sustainable funding. Identify care elements and cost of care elements for integrated care. Identify, inventory, and track core cost elements of integrated care, reimbursement sources and flow over duration of project. More detailed client outcomes measures for this model to support the above may include: 1. Screening tool usage (do primary care providers appropriately screen patients), and following referral protocols (do patients get referred to mental health when they screen positive) ; 2. Screening tool usage (do mental health providers appropriately screen patients), and following referral protocols (do patients get referred to PCP when they screen positive; 3. Pre- and post-tests (e. g., PHQ-9, Becks Anxiety Inventory, Brief Symptom Inventory, COJAK or other tools/in the case of warm handoff to physical health), screens may include no physical exam in last 12 months, Hx of Hypertension of diabetes, use of particular psychiatric medications etc.; 4. Patient satisfaction surveys; 5. Clinician satisfaction rates; 6. Medication usage; 7. Number of visits/utilization and level of care patterns; 8. Compliance with treatment goals; and, 9. Pre- and post-clinical indicators as appropriate. All outcomes will be monitored through standardized reporting as required by the Innovation Plan oversight structure. Outcomes data and evaluation results will be shared as required by the Innovation Plan oversight structure and as appropriate to advance treatment of this population in primary care and other settings. IX. Projected Costs The budget proposes to serve an estimated 1,600 clients at 4 sites at an average cost of $910,000 per site per year. X. Timeline ATTACHMENT E Innovations Plan – Detailed Description of Integrated Clinic Model County of Los Angeles – Department of Mental Health Timeframe Activities Jan 2010 Estimated Plan Approval from CA Dept of Mental Health Feb-Apr 2010 Competitive Bidding Process May—July 2010 Contract Negotiations, Board Approval and Awarding of Contracts Aug-Oct 2010 Start up and Staffing of Integrated Clinics Staff training Database and electronic care plan development Team orientation to the model MOUʼs and linkages for network finalization Menu of services and administrative structure and process finalization Begin to see clients Nov 1, 2010 Clinics begin screenings, integrative processes and service delivery 1st Quarterly Formative Evaluation and Reporting Assessment of program, processes and preliminary data making adjustments as necessary Measure the number or percentage of patients screened by initial provider, referred to integrated partner, and referred outside to specialty care; measure acuity levels, peer involvement and other specific data. Nov 2010-Jan 2011 Screening and integrated care and services continues Feb 1, 2011 2nd Quarterly Formative Evaluation and Reporting Administrative and clinical staff meet for mid-program assessment with adjustment of program or processes as necessary. Measure the number or percentage of patients screened by initial provider, referred to integrated partner, and referred outside to specialty care; measure acuity levels, peer involvement and other specific data. Feb-May 2011 Continue Integrated Services June 1, 2011 3rd Quarterly Formative Evaluation and Reporting and adjustment of program or processes as necessary Measure the number or percentage of patients screened by initial provider, referred to integrated partner, and referred outside to specialty care; measure acuity levels, peer involvement and other specific data. June 2011-Aug 2012 Continue Integrated Services One year assessment and reporting of program, CQI efforts and outcomes measures, with program adjustments as needed. Create vision for next steps for continuation of program or change recommendations. Measure the number or percentage of patients screened by initial provider, referred to integrated partner, and referred outside to specialty care; measure acuity levels, peer involvement and other specific data. Also, measure the number or percentage of patients transitioned to primary care ATTACHMENT E Innovations Plan – Detailed Description of Integrated Clinic Model County of Los Angeles – Department of Mental Health plus wellness center health home as permanent medical home. Sept-Dec 2012 Summative Evaluation/Final Report Assess results of evaluation and CQI efforts as basis for next steps in integration program and future efforts. Share results and learnings with various local, state and national audiences. ATTACHMENT F Innovations Plan – Detailed Description of Integrated Mobile Health Team Model County of Los Angeles – Department of Mental Health 
 
 
 I. Vision To reduce fragmentation and increase quality of services, a mobile, enhanced, integrated, multi-disciplinary team including physical health, mental health, and substance abuse professionals and other specialized staff managed under one supervisor will leverage multiple funding sources including capital for housing development and Federal Qualified Health Center (FQHC) funding to reduce homelessness and improve outcomes for individuals who are homeless, many of whom are identified as vulnerable, uninsured and from underrepresented ethnic populations and other groups. II. Innovations While other mobile team models exist, our Integrated Mobile Health Team model is innovative for several reasons. First, we are attempting to integrate care in a complex urban environment that is geographically widespread and maintain those services even after individuals move into permanent supportive housing. Second, the Integrated Mobile Health Team will be managed under one agency or under one point of supervision, which is unusual in Los Angeles’ complex system of multiple departments and agencies. Third, it will increase access to services and leverage multiple funding sources including Federal Qualified Health Center (FQHC) funding and capital for housing development which have not previously been tapped. III. Need addressed Homeless persons with mental health needs typically have a complex array of additional needs, including physical health and substance abuse care. Often their care, if accessed at all, is fragmented as a result of being provided by different agencies from various systems with several funding sources. To address consumers’ multiple needs more adequately, a wide array of services should be provided in an integrated manner, breaking down barriers between systems and providers, with the goal of achieving permanent housing. Homeless people with mental illness are more likely to have higher rates of morbidity and mortality than people with mental illness who live in stable, permanent housing. This difference is the result of a lack of access to healthcare, dental care, mental health care, drug/alcohol treatment, and a result of the adverse conditions experienced living on the streets. Even homeless people with mental illness who have moved into housing often become unstable and frequently lose that housing because they lack access to appropriate, accessible, and integrated services. Permanent supportive housing (PSH) is recognized as the preferred solution for people who experience chronic homelessness and mental illness. PSH enables the client to first become housed and then receive the services necessary to address their mental ATTACHMENT F Innovations Plan – Detailed Description of Integrated Mobile Health Team Model County of Los Angeles – Department of Mental Health 
 
 
 illness and other disabling conditions. It is virtually impossible to adequately treat mental illness, physical health, and substance abuse issues while the individual remains homeless. Initial findings from Los Angeles (LA) County’s Project 50 reveal that of the targeted most vulnerable and long-term homeless individuals, only 4% were receiving mental health services prior to housing; this figure increased to 91% after being housed and receiving some degree of integrated supportive services. Moreover, it has been demonstrated that PSH is cost-effective, reducing the use of city and county resources including such as costly crisis/emergency services. Even with the current stock of PSH, the services tend to be minimal and generally do not include physical health and substance abuse services; if they do the services are fragmented. A Shelter Partnership report on special needs housing in Los Angeles found that “of the 42 permanent housing projects surveyed, the vast majority (88%) reported that they provide supportive services. In 50% of these developments, the levels of services funding and staffing are below what Shelter Partnership determined to be the ‘consensus standards’ for permanent supportive housing.”1 Therefore, to more effectively end homelessness for the poorest and most vulnerable residents in Los Angeles County, we must outreach to these individuals who are located throughout the County using an integrated mobile health team and concurrently increase the stock of affordable, service enriched housing. There are financial resources available for the capital development and operating subsidies necessary for developing PSH, both scattered site and project-based, but there is no dedicated funding source for supportive services. This gap has been identified by affordable special needs housing developers as a disincentive to developing more PSH for those with mental illness and other co-occurring disorders. IV. Target Population 0. Access to services This model is designed for individuals with a diagnosis of mental illness, and their families, who are homeless including those living on the streets and in shelters or have recently moved into PSH from homelessness. Some of these individuals will be the most vulnerable individuals as defined by the Common Ground Vulnerability Index or other methods that determine those living on the street who are most likely to die in the next year or other methods based on community priorities. a. Individuals who have multiple disabling conditions and are living on the street and their families. 























































 1 “Survey of Special Needs Housing Projects Funded by the Housing Authority of the County of Los Angeles (HACOLA),” Shelter Partnership, www.shelterpartnership.org ATTACHMENT F Innovations Plan – Detailed Description of Integrated Mobile Health Team Model County of Los Angeles – Department of Mental Health 
 
 
 b. Individuals who have multiple disabling conditions and are living in shelters or transitional housing and their families. c. Formerly homeless individuals who have multiple disabling conditions and their families who have moved into PSH. With an enhanced integrated service model, the point of entry is through whichever need the client identifies, whether it be housing, physical health, mental health, or substance abuse. 1. Numbers to be served It is estimated that a total of 900 individuals and their families will be served each year (300 per team). This includes individuals who receive outreach services only and those that are engaged in more on-going services. The individuals to be served may include but are not limited to individuals targeted through the following programs: a. Project 500 – an expansion of the highly successful Project 50 which targeted the 50 most vulnerable, chronically homeless people in Skid Row; b. MHSA Housing Program – a project that provides funding for the development of new permanent supportive housing units. It is estimated that over the next year 425 new units will become available. c. Supportive Housing Alliance – an advocacy group comprised of supportive housing developers estimates that over the next year 211 PSH units will become available (there may be some overlap with the MHSA Housing Program units referenced above). V. Program Elements 1. Integrated Service Management Team Multidisciplinary health team (mental health, physical health, and substance abuse professionals and other specialized staff) who work under one agency such as a Federally Qualified Health Center or under one point of supervision. a. Staff from multiple disciplines, including but not limited to: i. Physical Health ii. Mental Health iii. Substance Abuse b. Team staff members, including but not limited to the following: i. Medical physician ii. Psychiatrist iii. Psychiatric social worker iv. Nurse practitioner v. Certified substance abuse counselor vi. Clerical support vii. Billing clerk viii. Benefit establishment/housing/employment specialists) ATTACHMENT F Innovations Plan – Detailed Description of Integrated Mobile Health Team Model County of Los Angeles – Department of Mental Health 
 
 
 ix. Peer advocate/Family advocate/Parent Partners 2. Funding Innovative funding mechanisms will leverage MHSA dollars in order to reach and serve the greatest possible number of people, and they will be developed to encourage the creation of more permanent supportive housing. MHSA funding will be used to support outreach and engagement and on-going services by the integrated mobile team. The team will work toward establishing benefits as quickly as possible to assure leveraging of other funding resources such as FQHC funding, Drug MediCal and Public/Private Partnership (for uninsured clients) The model tests the feasibility of leveraging of Federal resources available through an FQHC to provide services to uninsured clients given the FQHC’s rate structure. The model will determine gaps in allowable FQHC service funding for a fully integrated mobile health service model, and the MHSA funds needed for leveraging. Once individuals move from the streets and shelters into PSH units, the integrated mobile health team will continue providing services through the use of a project-based service voucher. These vouchers will be committed to housing developers that are interested in building PSH and will be used to leverage housing capital to develop more PSH units. The project-based service vouchers will be dedicated to PSH units similar to project based operating subsidies that are used to make the units affordable for a specific period of time. Developers will apply for project-based service vouchers for a specific number of PSH units dedicated to the MHSA focal population. DMH will make a commitment to the developer for a specific number of project-based service vouchers. The voucher indicates that the developer has access to integrated health, mental health, and substance abuse services (among others) through a mobile team. Funding will be tied to the housing units, but the service intensity would be based on the needs of the clients. In the event the client leaves the PSH project with the project-based service vouchers, the mobile team will continue to provide services regardless of their residence. ATTACHMENT F Innovations Plan – Detailed Description of Integrated Mobile Health Team Model County of Los Angeles – Department of Mental Health 
 
 
 3. Services Provided a. All mental health, physical health, and substance abuse services identified will be fully integrated into one client care plan that contains physical, mental health, and substance abuse client-centered treatment goals and objectives. b. May include tele-health or tele-psychiatry, connections to faith-based community services, peer support programs, and non-traditional approaches that match individual client interests. c. Service intensity is moderated according to the needs of the client. 4. Process of Providing Services: a. This is a client-centered, housing-first approach, using harm reduction strategies across all modalities of mental health, physical health and substance abuse treatment. b. Conducts outreach, engagement and service delivery in the streets, shelters, and in PSH that are tailored to the specific needs of the population served whether they are on the streets, in shelters or recently moved into PSH. c. Provides a bridge between the client and other supportive service providers who will then become the main source of on-going support and services, when appropriate. 5. Process of Providing Housing a. Housing needs are based on client choice and immediately addressed without “readiness criteria. ” b. Specially trained housing specialists that are part of the multi-disciplinary team will collaborate with the housing developers that have units available including those with project-based service vouchers, in addition to accessing Federal housing subsidies and other housing resources. c. Assist clients with completing any necessary housing applications, locating housing, and any other supports necessary to obtain housing. 6. Principles and Values a. Housing First – Immediately assists individuals to transition from homelessness to housing by providing housing of the individual’s choice without any prerequisites/conditions for mental health treatment or sobriety. b. Services are voluntary and focus on creating community. c. Multi-lingual and culturally competent – services are in the client’s preferred language are provided in a culturally-congruent manner. d. Harm reduction – strategies that are designed to reduce the risk of harm associated with certain behaviors such as drug abuse. e. Client-centered – services driven by the client’s own goals and interests. ATTACHMENT F Innovations Plan – Detailed Description of Integrated Mobile Health Team Model County of Los Angeles – Department of Mental Health 
 
 
 f. Holistic support – assists the client with health, mental health, and substance abuse needs, but also with other services such as transportation, follow-up, encouragement and communication. A holistic approach will assist clients in attaining and completing services in a linguistically and culturally competent manner. g. Community-based natural support systems – The mobile teams work within and actively strengthen the natural support systems of specific communities, so that these supports can be part of the clients’ recovery process. h. Advocacy – Includes efforts to change systems in order to better support the integration of care and improved outcomes for the client. Collect and analyze outcome-based data in order to inform efforts for systems change. VI. Outcomes Service level outcomes: 1. Reduced homelessness 2. Improved mental health and physical health 3. Increased number of PSH units for the homeless with mental illness 4. Increased housing retention 5. Reduced medical and psychiatric ER visits and other high-cost services 6. Reduced medical and psychiatric hospitalizations 7. Increase benefits establishment 8. Reduced incarcerations 9. Increased involvement in self-help, peer support, and community building activities. Increased self-sufficiency through public benefits, income support, education, vocational training, and connections to employment opportunities System change outcomes 1. Over time, the model will achieve financial sustainability by leveraging funding through MediCal, Drug MediCal, FQHCs, and other existing programs. 2. Provision of integrated physical health, mental health and substance abuse services under one point of supervision and the braiding of several different funding streams. Transformation learning questions: 1. How do we design and manage an integrated health, mental health and substance abuse service delivery model that best leverages existing funding for physical health and substance abuse services (in addition to mental health services) that ultimately can become financially sustainable? 2. What barriers exist within public systems that inhibit collaboration and integrated care? 3. What funding gaps exist among existing public service systems that must be addressed to assure high-quality care for homeless mentally ill clients? ATTACHMENT F Innovations Plan – Detailed Description of Integrated Mobile Health Team Model County of Los Angeles – Department of Mental Health 
 
 
 4. What program design features increase the effectiveness of the program to engage the hardest-to-reach consumers? 5. Will housing developers have more interest in accepting hard to serve individuals with multiple intense needs who are homeless and mentally ill if integrated services are available to support their transition or and retention of PSH? 6. What program features are necessary to increase the supply of PSH? a. To increase the number of developers willing to develop PSH b. To increase the number of PSH units c. To increase the number of service providers involved in PSH projects d. To increase the range and integration of services available to consumers 7. What program features are necessary to encourage mental health services providers to create new partnerships with PSH developers? 8. How can housing developers and service providers work together to better meet the needs of mentally ill, homeless consumers? 9. What are potential mechanisms to bring this type of integrated mobile health team to scale and to sustain it over time? VII. Projected costs The attached budget delineates the spending plan for three integrated mobile health teams each serving 300 clients a year which includes those who are outreached to but not engaged in services and those engaged and receiving on-going services. Based on increased numbers of clients obtaining MediCal over the course of the program, the mix of MHSA/leveraged funding will change each year with the MHSA funds decreasing each year. 1. Projected cost for three integrated mobile health teams over two years is $8,714,238 (i. e. Year One: $5,220,024; Year Two: $3,494,214). 2. Portion of cost per year for three teams dedicated to two peer/family/parent advocates per team: $240,000 per year. VIII. Implementation Timeline Timeframe Activities Jan 2010 Estimated Plan Approval from CA Dept of Mental Health Feb-Apr 2010 Engage in Competitive Bidding Process May—July 2010 Contract Negotiations, Board Approval and Awarding of Contracts Aug-Oct 2010 Start up and Staffing of Integrated Mobile Health Teams Nov 1, 2010 1st Quarterly Formative Evaluation and Reporting Design one organizational chart that defines one point of supervision and there is one integrated set of policies and procedures. Establish a baseline of existing funding sources and the ATTACHMENT F Innovations Plan – Detailed Description of Integrated Mobile Health Team Model County of Los Angeles – Department of Mental Health 
 
 
 number of clients on benefits and projected amount of leveraging required for viability. Nov 2010-Jan 2011 Outreach and Engagement Feb 1, 2011 2nd Quarterly Formative Evaluation and Reporting Confirm that the Integrated Mobile Health Team is as is defined in the organizational chart and the team is following the one set of policies and procedures. Determine that the Integrated Mobile Health Team is actively seeking to maximize leveraging opportunities and is working to establish benefits for new clients. Feb-May 2011 Integrated Mobile Health Team services provided June 1, 2011 3rd Quarterly Formative Evaluation and Reporting Confirm that the Integrated Mobile Health Team’s organizational chart and polices and procedures are effective and make modifications as necessary. Determine if there is an increase in leveraged funding (including benefits establishment). Budget is revised as needed to decrease MHSA revenue utilization as other funding increases. June 2011-Aug 2012 Integrated Mobile Health Team services provided Sept-Dec 2012 Summative Evaluation/Final Report Confirm that any revisions that are made to the organizational chart and the policies and procedures are re-evaluated for effectiveness and if successful, integrated into a best practice model. Determine if there is a decrease in MHSA revenue utilization as a result of maximizing other leveraging resources. Share results and learnings with various local, state, and national audiences. ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health I. Vision The Community-Designed Integrated Service Management Model (Community-Designed ISM) addresses the fragmentation inherent in the current system of care by building on the strengths of a community, especially underserved ethnic communities. Collaboration and partnerships between regulated entities, contract providers and community-based organizations will integrate health, mental health, substance abuse, and other needed care to support the recovery of consumers, with particular attention to under-represented ethnic populations. The Community-Designed ISM model: 1. Uses a multi-disciplinary, integrated service management team consisting of professional and life-experienced consumers, family members, parents, caregivers, cultural brokers and community members, particularly from communities being served; 2. Draws upon the resources from a network of regulatory providers (i. e., mental health, health, substance abuse, child welfare, and other formal service providers) working with a foundation of community-based, non-traditional, and natural support systems; 3. Coordinates the integration of the regulatory providers and community-based resources through: (a) Community –Designed, Peer-based Outreach and Education; (b) Community -Designed Peer-Based Enhanced Engagement practices; (c) Community-Designed Peer-Based Enhanced Linkage and Advocacy (d) Harmonious Intertwining of Regulatory and Non-Traditional Services and Supports; 4. Is rooted in culturally-effective principles and values and, 5. Identifies the barriers to service delivery for under-represented populations and strives to reduce them. II. Innovations While similar programs may exist, our Community-Designed ISM is innovative for several reasons. First, we are attempting to integrate care in a large, diverse urban environment with complex systems of care. Second, the model differentiates specific needs and approaches for five distinct under-represented ethnic communities. Third, the model focuses on community self-direction for integrated service delivery. Fourth, we will also integrate peers into the model’s mix of formal and non-traditional providers while we integrate physical health, mental health and substance abuse care. ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health III. Need Addressed The Los Angeles County Department of Mental Health (LAC-DMH) is committed to working alongside ethnic and cultural communities that have been historically on the periphery of the mental health system. These communities, referred to as UREP (Under-Represented Ethnic Populations), provide LAC-DMH with a wealth of resources and information on how to best serve currently unserved, underserved, and inappropriately served ethnic populations with the goal of bettering their mental health outcomes and overall well being. In Los Angeles County, there are five distinct UREP subcommittees representing the mental health needs and concerns of their communities. These include African Immigrant/African American (A/AA), American Indian (AI), Asian Pacific Islander (API), Eastern European/Middle Eastern (EE/ME) and Latino. By establishing these five UREP subcommittees as a staple in various MHSA planning and stakeholder processes, Los Angeles County created a learning lab for the formal public mental health system to develop culturally competent approaches and services successful at reaching marginalized ethnic communities. As a result, these five UREP groups provide their input about the distinct cultural norms of their communities and how these norms influence mental health needs and service approaches. Hence, development, planning, and implementation of Mental Health Services Act (MHSA) services builds upon this collective wisdom by ensuring all MHSA programs embody culturally-competent approaches endorsed by and effective for the communities they aim to serve. IV. Target Population 1. Access to services The Community-Designed ISM is designed to serve the health, mental health, and substance abuse needs of under-represented ethnic populations that have limited access to culturally-appropriate services and/or will be potentially displaced from services due to funding gaps. In addition, these populations include: 1. Families/individuals who have a history of dropping out of services; 2. Linguistically-isolated individuals/families; 3. Families that have not accessed services due to stigma; and, 4. Families that have not benefitted from services or have received inappropriate services. With the ISM model, the point of entry to services can be through various sites including schools, places of worship, primary care clinics, or other community agencies. 2. Numbers to be served ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health Over the course of two years, we are proposing to serve 2,800 highly vulnerable families through this project: FY 10-11 FY 11-12 UREP GROUP GEOGRAPHIC TARGET EST. # OF FAMILIES EST. # OF FAMILIES TOTAL # FAMILIES African/African-American Service Area 6 232 232 464 American Indian Countywide 176 176 352 Asian/Pacific Islander Countywide 320 320 640 Eastern European/Middle Eastern Service Area 2 or 4 120 120 240 Latino 3 Service Areas w/ largest concentration of Latinos and lowest penetration rates 552 552 1,104 Total 1,400 1,400 2,800 V. Program Elements The following sections describe each of the five elements of the ISM model. A. Element Set 1: Integrated Service Management Team The team consists of professionals, paraprofessionals, and peers with the professional, cultural, and linguistic skills and resources to integrate mental health, primary care, and substance abuse services. 1. Licensed Staff from multiple disciplines, including but not limited to: • Health • Mental Health • Substance Abuse • Nursing • Homeopathic physician • Chiropractor • Acupuncturist ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health 2. Professionals that provide culturally defined services, including but not limited to: • Case managers • Non-Traditional Healers • Community based health practitioners • Nutritionists • Teachers/instructors • Health and fitness trainers • Herbalists • Culturally sanctioned tribally recognized professionals 3. Peers and/or life experience workers, including but not limited to: • Wellness Promoters • Promotoras • Peer Bridgers • Parents • Family members 4. Cultural brokers and resource extenders, including but not limited to: • Churches/religious leaders • Community-based business leaders • Volunteers/voluntary organizations B. Element Set 2: Integrated Care Network The network consists of formal and community-based non-traditional providers that will break down the silos created by services and treatments dictated by compartmentalized funding. 1. Formal providers including mental health, health, and substance abuse service providers 2. Community-based non-traditional providers include, but not limited to: • Faith-based organizations • Voluntary associations • Community-based organizations providing an array of services including but not limited to legal assistance, social and family support services, immigration services, recreational services, and educational and vocational services. C. Element Set 3: Integrated Care Model ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health Community-Designed Peer-Based Engagement and Education recognizes engagement as an ongoing, multiple contact process and the importance of culturally-appropriate education to increase awareness and decrease stigma. Capacities: a. ISM will conduct community-designed peer-based enhanced engagement and education with current and/or potential consumers and family members. This type of engagement would: b. Understand, respect, and honor the specific cultures, traditions, and networks of each community; c. Address multiple challenges (e. g., lack of knowledge of existing services and treatment options, high rates of recidivism, and stigma) that impair these communities from accessing and maintaining services; d. Serve UREP members who are also homeless, uninsured, LGBTQ, deaf and hard of hearing, and blind and visually impaired, among others; e. Provide educational services about mental illness and health issues, including substance abuse; f. Provide screening to formal and community services; g. Provide culturally competent referrals for the appropriate level of care required by clients/family members; h. Outreach, engage and provide appropriate referrals and linkage to client/family members from all non-stigmatizing community accepted location(s) (e. g., Church, school, community based organization, primary care clinic, etc) ; i. Develop strong working relationship with community organizations and leadership; j. Provide training, education, and coaching to community organizations and leaders; k. Use success stories to help de-stigmatize mental illness; and, l. Use settings and locations that would appeal to ethnic groups and not be identified as a treatment clinic. D. Community-Designed Peer Based Outreach and Education Capacities a. Conduct community-designed peer-based outreach through collaboration with community-specific organizations and other community leaders; b. Use ethnic media by identifying the media outlets by specific community and maintaining relationships with them; c. Conduct community forums and town hall meetings; d. Recognize and leverage the word-of-mouth capabilities of current and former clients and family members to reach other community members; and, ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health e. Prioritize the use of properly translated materials to increase family members’ access to information and education. E. Community Designed Peer-Based Enhanced Service Linkage and Advocacy Capacities a. Assess the various mental health, physical health, substance abuse and other needs of consumers and develop integrated care plans; b. Link individuals to formal services and community-based services; c. Follow up to ensure that the client and/or family member was able to access the services, such as providing transportation or giving encouragement; d. Facilitate communication among service providers to ensure that the range of services is identified and knowledge of these resources is shared; e. Facilitate communication among service providers to develop trust and a collaborative spirit; and, f. Conduct advocacy, if needed, to assist families to secure needed qualified services and break down institutional barriers. F. Element Set 4: Process ISM Client Flow Process a. Clients may already be in the system at every level of treatment and recovery; b. Potential clients may enter the system through a variety of entry points including community programs that are not specific to mental health; c. Potential clients will be screened by the ISM teams to identify client needs beyond determining acuity levels; d. ISM will collect appropriate information on each client or family member such as how they entered the ISM program, identifying markers, types of services provided, etc. ; e. ISM will track key outcome data such as recidivism rate, focal populations served, areas of improvement, how services were delivered, etc. ; f. ISM will survey client satisfaction periodically to provide feedback to the organizational participants so they can improve, change, or prioritize service delivery; and, g. ISM will encourage communication from clients and family members to ensure that services are appropriate and helpful. G. Element Set 5: Principles, Values, Standards a. Holistic Support – The ISM model will use a holistic, community-designed peer-based, culturally competent approach to ensure clients are appropriately served. This approach means assisting the client with health, mental health, and substance abuse needs, and also with other services such as transportation, follow-up, advocacy, encouragement and ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health communication. A holistic approach by the ISM will assist clients in attaining and completing services in a culturally-competent manner. b. Culturally and Linguistically-Competent Services – Ensure that all services provided by organizations and staff are culturally competent in planning and implementation. Emphasis is placed on the communities of each targeted population providing the information to ensure this. c. Network Approach – ISM programs will use networks or collaboratives that are grounded in their respective communities to deliver services. This approach may integrate the services at a single site, an existing network of providers, or a community-based network. The network or collaborative will strive for a horizontal-based association. These collaborative may include grassroots, faith based organizations, schools, and other entities. d. Community-Based Natural Support Systems – ISM programs will work within and actively strengthen the natural support systems of specific communities, so that these supports can be part of the clients’ recovery process. e. Peer-Driven Services – ISM programs will rely on clients, family members, parents and caregivers to inform service providers on what is helpful and needed to assist them towards recovery. Peers and staff will strive to work with one another to develop a trusting relationships that foster true partnership and equality so mutual goals can be reached. f. Advocacy — ISM programs will advocate for changes in the system of care that supports the integration of services and improved outcomes for the client, as well as advocate on behalf of families to break down institutional barriers g. Data driven outcomes – ISM programs will collect and analyze outcome-based data to track and adapt integrated care plans that will strengthen system change. h. Oversight mechanism – The ISM model recognizes that past systems of care often resulted in disparity when one agency or organization became too powerful. Often this done out of necessity to centralize functions or in the name of cost efficiency. During the implementation period, the UREP Work Groups can provide oversight capacity to ensure that the vision of this innovative model is maintained and proper balance is kept among the participating agencies. Trust takes time to develop, and balance in the presence of great changes must be nurtured and protected. i. Cost Effectiveness – ISM programs will collect and analyze their outcomes to track the cost effectiveness of the services, in particular whether or not the identified focal populations of uninsured, UREP, and homeless are being served in a compassionate and efficient manner. VI. Services Provided ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health 1. Services will be fully integrated into one family care plan that contains physical, mental health and substance abuse family-centered treatment goals and objectives. 2. Services may include ethnic specific services such as non-traditional healers, connections to faith-based community services, herbalists, culturally-sanctioned tribally-recognized professionals, peer support programs, and other community-based non-traditional approaches that match ethnic specific interests and needs. 3. Service intensity is moderated according to the needs of the family. 4. Process of Providing Services a. This model is a family-centered, community-designed approach, using culturally and holistically derived strategies across all modalities of mental health, physical health, and substance abuse treatment. b. ISM will conduct culturally-effective and competent community-designed peer-based outreach, engagement and service delivery in the communities where under-represented families reside. c. ISM will provide a bridge between the family and other formal and community-based supports that will then become the main source of ongoing support and services when needed. VII. Principles and Values One of the cornerstones of Mental Health Services Act (MHSA) planning efforts in Los Angeles County is to empower UREP groups to work in concert with LAC-DMH to expand services to include culturally and linguistically-competent approaches. UREP communities endorse the following over-arching principle for establishing effective services for ethnic communities: “To provide effective mental health treatment to UREP communities, the public mental health system must adopt culturally competent and holistic strategies anchored in and supported by UREP communities that complement and enhance formal mental health services.” Approaches endorsed by LAC-DMH UREP cultural brokers and community partners include: a. Community-designed peer-based outreach and engagement that is “focused”, “accountable” and defined by community experts. b. Successful linkage and/or continuous follow-up until linkage is established. c. Collaboration with community partners and cultural brokers to sustain community services. d. Coordination of service. e. Community education and training. f. Inclusion of spirituality and holistic (mind, body, and spirit) approaches to service. g. Advocacy. h. Deletion of geographic boundaries to service provision. i. Building community capacity to provide on-going services that complement public services and, ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health j. Leveraging community strengths and resources to maximize all resources. By employing theses approaches across MHSA Plans and planning efforts, UREP groups believe the public mental health system will expand its capacity to appropriately serve UREP communities. VIII. Outcomes and Evaluation A. System Change Outcomes Implementation of the ISM potentially transforms the formal mental health system overall in LA County for UREP communities. If fully successful, implementation of UREP-specific ISMs will create the following system change outcomes: 1. The integration of mental health, physical health, and substance abuse services through a community-designed model of care that is anchored in the resources of the diverse UREP communities and uses community providers as a starting point for developing family care plan and, 2. Development of holistic, culturally-relevant family care plans that adds mental health as a component rather than a primary focus of recovery. B. The effectiveness of the ISM in producing system change outcomes will be evaluated using the following six domains: 1. Integrated Care: It is anticipated that the learning achieved in this domain will include successful strategies used to integrate mental health, health and substance abuse services. 2. Service Levels/Access: The ISM is expected to contribute to learning by identifying appropriate service levels for each population needed to achieve superior outcomes in the mental health, physical health, and substance abuse arenas. ISMs are expected to reveal potential barriers to access to care, service retention, development of appropriate referrals systems and community capacity building for UREP populations. 3. Quality of Care: ISMs will inform Department of the most effective strategies to be used to maximize the quality of care for UREP Populations. 4. Community Capacity Building and Overall Improvement: ISMs are designed to help determine the extent to which the integration of mental health, health and substance abuse services for a UREP population translates into community improvements as it relates to capacity building and the provision of culturally competent and community defined services which increases access to services and service retention. 5. Stakeholder Satisfaction: ISMs will survey the satisfaction of three primary stakeholder groups, (including UREP consumers, community-based agencies and community partners and the current providers of mental health care) in providing culturally-competent, community-designed services to UREP communities. ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health 6. Cost: ISMs facilitate leveraging of community resources to build culturally competent services for UREP consumers. In addition, ISMs will review the actual cost of delivering integrated care in an effective and culturally competent manner. C. System Change Evaluation: To evaluate system change using these six domains the ISMs will address the barriers of the current mental health system as follows: Current System Desired System Measures Goals Excludes community-based resources Community-based resources are integral service providers Increase the number of community-based partner providers Increase the types of community-based partner providers Number of community-based partner providers at the beginning of the program will increase within 18 months. Types of community-based partners will increase within 18 months. Mental Health/Substance Abuse/ Health services located in different settings resulting in fragmented care. Programs provides mental health AND substance abuse AND health care. Every program provides mental health AND substance abuse AND health care. Survey of all programs for an increase in integration efforts of Mental Health/Substance Abuse/ Health services Little to no culturally competent peer-based outreach and education to UREP communities Programs provide culturally-informed peer-based outreach, engagement, linkage, education and training to UREP communities All ISMs provide culturally informed peer-based outreach, engagement, linkage, education, and training to their targeted UREP community Increase in the number of programs providing outreach, engagement, linkage, education, and training to their targeted UREP community Assessment by community leaders regarding the linguistic and cultural appropriateness of the outreach, engagement, linkage, education, and training. DMH policies create barriers to the inclusion of non-traditional healing services DMH services include services provided by non-traditional practitioners Develop strategies to address barriers to the inclusion of non-traditional healing services Identify barriers and strategies to address barriers Credential Non-traditional practitioners to accept referrals from a newly developed referral system ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health C. ISM Specific Learning Questions and Projected Outcomes Each UREP ISM has specific outcomes that are relevant to their individual communities and seek to answer specific learning questions. These are as follows: A-1a. African/African-American (A/AA) UREP Learning Questions: 1. Are we able to provide sustainable services over an extended period of time by developing leaders in the A/AA community through training and coordination? 2. Do we increase the likelihood that A/AA consumers will complete services and sustain increased levels of wellness (thereby reducing their need for intensive services for extended periods of time) through providing a community/Holistic service approach? C-1b. African/African-American (A/AA) UREP Outcomes: 1. Creation of community partnerships and collaborations with community based organizations and groups to whom clients were referred; and, 2. Consistent participation in mental health treatment and supportive services to completion. C-1c. African/African-American A/AA ISM Evaluation: 1. Development of Partnerships: Count of community partners and community-based agencies who referred clients to ISM; and, 2. Consistent participation and completion. a. Consistent Participation: No more than one missed appointment for every four scheduled appointments. b. Completion: Client and ISM team’s mutually agreed upon termination of regular services. C-2a. American Indian Learning Questions: 1. What mechanism can be developed to address credentialing of, and quality of services provided by non-traditional practitioners? 2. Can identification of non-traditional healers and development of a referral system of such individuals lead to cost-effective methods to provide culturally-based recovery services? C-2b. American Indian UREP Outcomes: ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health 1. Development of strategies addressing barriers to identifying and credentialing non-traditional practitioners to provide culturally competent quality services and, 2. Increase the number of consumer referrals to non-traditional practitioners by developing a referral system linking consumers to credentialed healers. C-2c. American Indian ISM Evaluation: 1. Development of a final report identifying systemic barriers and policies preventing credentialing of traditional practitioners. This final report will include: a.) The articulation and implementation of strategies to overcome barriers. b.) The number of practitioners credentialed and, c.) The number of credentialed practitioners receiving referrals as a result of the project. 2. Increase in Consumer Referrals to Non-traditional Practitioners: Count of consumer/family referrals linked to non-traditional practitioners through newly developed referral system for physical heath, mental health and substance abuse treatment options. C3a. Asian Pacific Islander Learning Questions: 1. What program or approach leads to higher utilization of mental health services (i.e. wellness activities, substance abuse counseling) for APIs? 2. Can a countywide wellness approach effectively meet the linguistic diversity and geographic spread of API consumers in LA County? 3. Can a countywide wellness approach effectively engage grassroots organizations and community groups in a way that is mutually beneficial for both the community-based organizations and the public mental health agencies? 4. What kind of wellness activities aid in the recovery process for API consumers? 5. What kinds of wellness activities satisfy the needs of family members? 6. Will wellness activities and community partnerships provide good entry points for potential clients to enter the public mental health system? 7. What type of approach results in higher consumer and family satisfaction about services from the public mental health system? 8. Does education about mental illness increase access to care by lowering barriers in API populations? 9. Does a countywide, culturally and linguistically appropriate, community collaborative approach decrease the fragmentation in delivery of services producing better client participation in treatment and family member support? ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health C-3b. Asian Pacific Islander UREP Outcomes: 1. Increase access for marginalized API ethnic groups that are not currently served or are underserved. 2. Provide cost efficient and culturally effective mental health and substance abuse services though partnerships between community-based organizations and public mental health providers. 3. Increase satisfaction from community organizations about working with public mental health providers. 4. Increase family member involvement in the client’s recovery for more sustained periods of time. 5. Increase the number of consumers who become more integrated into their community, find meaningful job opportunities and learn useful skills or develop new interests and, 6. Increase the number of consumers and family members who take leadership or instructional roles in the wellness programs. C-3c. Asian Pacific Islander ISM Evaluation: 1. Increase access for marginalized API ethnic groups that are not served or are currently underserved or inappropriately served. Measurement of Access: For API families that are not served, underserved or inappropriately served increasing the total number of community-utilized points of entry (e.g., primary care offices, places of worship, schools, etc) and referrals to culturally appropriate and sensitive physical, mental health and substance abuse treatment options. 2. Increased collaborations and partnerships between API CBOs and public mental health organizations. Measurement: Develop a baseline and chart each new partnership. 3. Better recovery rates for the consumer. Measurement: a. Track the progress of consumers using some specific parameters. b. Track the satisfaction of family members on the progress of the client and, c. Set up parameters to measure various categories like job placement, new skills learned, etc. and monitor this in each client. 4. Higher satisfaction from clients, family members, and collaborative agencies. Measurement: Surveys of clients, family members and collaborative agencies to measure the levels of satisfaction. Monitor what they feel is successful and what is not. C 4a. Eastern European/Middle Eastern Learning Questions: 1. Can a culturally-competent, one-stop referral and outreach center meet all the physical, mental and substance abuse needs of the Eastern- ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health European/Middle-Eastern communities and can it be replicated for other culturally diverse communities? C-4b. Eastern European/Middle Eastern UREP Outcomes: 1. Increased access to culturally sensitive physical, mental and substance abuse treatment options. 2. Increased client awareness of mental health issues through culturally appropriate outreach and education and, 3. Increased community partnerships between grass roots/cultural organizations and mental health agencies. C-4c. Eastern European/Middle Eastern ISM Evaluation: 1. Increase access to culturally sensitive physical, mental health and substance abuse treatment options: a. Measurement of Access: For EE/ME families that are not served, underserved or inappropriately served increasing the total number of community-utilized points of entry (e.g., primary care offices, places of worship, schools, etc). 2. Increased EE/ME community awareness of mental health issues. a. Measurement of Increased Awareness: survey of randomly selected EE/ME community individuals regarding mental health issues. 3. Creation of community partnerships between service organizations and mental health agencies. a. Measurement of creation of community partnerships: count of agencies who referred clients and agencies to whom clients were referred. C-5a. Latino UREP Learning Questions: 1. Can a culturally-competent ISM decrease barriers to access for monolingual, under-served, unserved, and inappropriately served Latino communities that are uninsured and/or indigent. C-5b. Latino UREP Outcomes: 1. Increased access to services for uninsured and/or indigent families served 2. Increased community partnerships between grass roots/cultural organizations and mental health agencies C-5c. Latino ISM Evaluation: 1. For Latino families that are unserved, underserved, or inappropriately served – increase the total number of community-utilized points of entry (e.g., primary care offices, places of worship, schools, etc) and referrals to ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health culturally appropriate and sensitive physical, mental health and substance abuse treatment options and, 2. Creation of community partnerships: count of agencies that referred clients and agencies to whom clients were referred. ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health IX. Funding/Leveraging The total amount of MHSA funding required for the ISM model is 15,997,800 over two years. This amount funds each individual UREP-specific ISM as follows: ISM Proposed Funding (In Millions of Dollars) by FY, UREP Group and Service Area UREP GROUP FY 09-10 FY 10-11 TOTAL FUNDING FY 09-10 EST. # OF FAM FY 10-11 EST. # OF FAM TOTAL # FAM SAs African/African-American $1,326,385 $1,326,385 $2,652,770 232 232 464 SA 6 American Indian 1,005,079 1,005,079 2,010,158 176 176 352 CW Asian/Pacific Islander 1,823,870 1,823,870 3,647,740 320 320 640 CW Eastern European/ Middle Eastern 685,123 685,123 1,370,246 120 120 240 SA 2 or 4 Latino 3,158,443 3,158,443 6,316,886 552 552 1,104 3 SAs Total $7,998,900 $7,998,900 $15,997,800 1,400 1,400 2,800 The amounts proposed for each UREP group are based on a weighted compilation of the following data: poverty population (40%), prevalence rates (30%); penetration rates (30%). Cost Per Services for All Groups Service Annual Cost Per Family % of Annual Cost Per Family Total # of Families Total Cost Medication $2,700 23.63% 2,800 $3,780,000 Mental Health 2.250 19.69 2,800 3,150,000 Health 1.800 15.75 2,800 2,520,000 Substance Abuse 1.800 15.75 2,800 2,520,000 Client Supportive Services (Flex Funding) 1.927 16.86 2,800 2,697,800 Peer-Based O/E, Education & Linkage 900 8.31 2,800 1,330,000 Total $11.427 100.0% 2,800 $15,997,800 ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health The ISM model will leverage MHSA funds with community resources. MHSA funding will be used to support: (a) Integrated care and support (e.g., health, mental health, substance abuse, screenings, assessment, tracking and follow-up); (b) Community-designed peer-based outreach, engagement, and education (e.g., education, training, technical assistant, follow-up by consumers, parents, family members, promotores, and community members). (c) Community-designed peer-based enhanced service linkage and advocacy (e.g., transportation, linguistic support and follow-up by consumers, parents, family members and promotores) and, (d) Development of formal and informal network of providers. IX. Implementation Timeline Timeframe Activities Jan 2010 Estimated Plan Approval from CA Dept of Mental Health Feb-Apr 2010 Competitive Bidding Process May—July 2010 Contract Negotiations, Board Approval and Awarding of Contracts Aug-Oct 2010 Start up and Staffing of ISM Teams. Monitor and review the number and types of participating community-based partner providers. Nov 1, 2010 1st Quarterly Formative Evaluation and Reporting. Identify, monitor, and address barriers (both internal and external to the Department) to implementation of model and develop a plan to ameliorate barriers. Nov 2010-Jan 2011 Outreach, Engagement, Linkage, Education and Training. Evaluate and explore the essential components leading to successful facilitation of culturally informed peer-based outreach, engagement, linkage, education and training to ethnic ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health communities. Feb 1, 2011 2nd Quarterly Formative Evaluation and Reporting. Determine and measure the extent to which ISM programs provide service integration management through survey of participating clients, providers and administrators. Feb-May 2011 ISM Services Provided to Families June 1, 2011 3rd Quarterly Formative Evaluation and Reporting Measure the extent to which consumers are completing services (measure rate of recidivism); evaluate how effective non-traditional community-based providers within each ISM have been for each ethnic group; assess if barriers to implementation of model and access to services have been reduced; are the physical, mental and substance abuse needs of the communities being met through the individual models. June 2011-Aug 2012 ISM Services Provided to Families Gather information on the number of non-traditional community-based partners who are providing services to clients. Sept-Dec 2012 Summative Evaluation/Final Report Share results and learnings with various local, state and national audiences. ATTACHMENT G Innovations Plan – Detailed Description of Community-Designed Integrated Service Management Model County of Los Angeles – Department of Mental Health 






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API;
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 Formal
and
Community
Based
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 Principles and Values Holistic support; culturally and linguistically competent services; network approach; community based natural support systems; peer driven services; advocacy; data driven outcomes; oversight mechanism; cost effectiveness Community‐Designed
Peer‐Based
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education,
training,
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 Peer‐Based
Enhanced
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transportation,
linguistic

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follow‐up
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 parents,
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 ATTACHMENT H Innovations Plan – Detailed Description of Integrated Peer-Run Model County of Los Angeles – Department of Mental Health I. Vision A. An Integrated Peer-Run Model supports people with mental health needs who may also have health and/or substance abuse issues to become well and stay well by providing new programs that are designed and run by people with lived experience of mental health issues. This model targets uninsured adults seeking services through two innovative strategies: Peer-Run Integrated Services Management (PRISM) and Alternative Peer-Run Crisis Houses. B. PRISM is a consumer-driven, holistic alternative to formal services that allows uninsured peers to secure needed health, mental health and substance abuse options as part of a program designed to support and empower people to take responsibility for their own recovery. PRISM utilizes a “whatever it takes” philosophy in a context of personal choice. It is innovative in that it is a team approach that involves peers helping peers. C. Peer-Run Crisis Houses are consumer-driven, holistic alternatives to hospitalization and are designed to provide a warm, safe, welcoming environment for uninsured people in psychiatric distress who are not a danger to others. These houses will be located in two places in separate service areas, and one of them will be dedicated to providing peer support to people in crisis who are being released from jail. D. In both strategies, people in recovery from mental health, health and/or substance abuse issues will develop reciprocal relationships with uninsured people like themselves who are dealing with similar issues and who may be in crisis or dealing with trauma. E. Both strategies are culturally competent in that the adults involved will be supported by peers who are similar to them linguistically and ethnically and by peers who respect and value cultural differences. II. Needs and Problems Addressed The Integrated Peer-Run Model addresses three types of problems in the public mental health system. 1. The first is the fragmentation of mental health, health, and substance abuse services for uninsured people with mental health needs who may also have health and/or substance abuse issues. Providing services in an integrated manner through PRISM and the Peer-Run Alternative Crisis House can better address these multiple needs. 2. The second is a systems problem. People experiencing a mental health crisis—whether insured or uninsured—lack alternatives to institutional and more costly options, such as hospitals and Urgent Care Centers. The Peer-Run Alternative Crisis House provides a safe place to successfully resolve a crisis for people who choose not to go into a mental hospital. It is also ATTACHMENT H Innovations Plan – Detailed Description of Integrated Peer-Run Model County of Los Angeles – Department of Mental Health potentially a more cost-effective alternative within the public mental health system to provide support to people experiencing a mental health crisis. 3. The third problem is also a systems problem. The public mental health system has not effectively and fully integrated peer-run programs into the array of public mental health services and supports for uninsured people with mental health issues. The proposed Integrated Peer-Run Model can help ascertain the extent to which peer-run strategies can be fully integrated as part of the array of services and supports. III. Target Population A. The primary target populations to be served by this model are: 1. Uninsured adults with a mental health issue seeking support (i. e., PRISM) 2. Uninsured adults with a mental health issue experiencing a crisis (i. e., Alternative Peer-Run Crisis Houses) B. Sub-Populations 1. Uninsured adults with mental health, health, substance abuse issues who may also be homeless; 2. Uninsured adults who are from UREP communities; 3. Uninsured adults from GLBTQI, Deaf or Hard-of-Hearing, and Blind or Visually Impaired communities; 4. Family members, parents/caregivers with children who may be uninsured and themselves wanting support. C. Number of people to be served 1. PRISM will serve 300 unduplicated consumers per year. 2. Alternative Peer-Run Crisis Houses will serve 216 unduplicated consumers per year. IV. Innovation The Integrated Peer-Run Model brings three important innovations to peer-run strategies in the context of the Los Angeles County public mental health system. 1. The first is the use of an Integrated Service Management (ISM) team approach to peer-run strategies. The ISM team that is fully supervised, administered, and implemented by peers in terms of the coordination of mental health, health, and substance abuse services is new. 2. The second innovation is bringing together two peer-run strategies under one model. In this case, PRISM and the Peer-Run Alternative Crisis House will work in tandem to offer consumers a broader array of peer-run supports. 3. The third type of innovation is the integration of multiple forms of peer supports. The Integrated Peer-Run Model seeks to effectively coordinate and deliver different types of peer services to support the consumers’ recovery. Peer support can come from consumers in recovery, parents, family members, and caregivers. This model can generate a better ATTACHMENT H Innovations Plan – Detailed Description of Integrated Peer-Run Model County of Los Angeles – Department of Mental Health understanding of the most effective to coordinate multiple forms of peer support. V. Definition of Roles A. Peer specialists (“bridgers”, advocates, supporters) will primarily support their peers in addressing expressed needs. The peer relationship, based on reciprocity, individual choice, and personal responsibility will inform the process of identifying and obtaining self-help options and professional services. B. “Peers” can also refer to other individuals who have lived experience with mental health issues (family members, parents or caregivers). 1. An individual whose family member(s) has had mental health issues can function as a Family Specialist to a family member in crisis. 2. A parent/caregiver with children who have had mental health issues can function as a Parent Partner with parents/caregivers who are in crisis and also have children who have mental health issues. VI. Program Elements The PRISM Team Strategy and the Peer-Run Crisis House teams focus on supporting peers in crisis or psychiatric distress in identifying what will be most helpful to them in the present and in building hope and confidence in their ability to reach the goals they set for the future. A. Program Element Set One: Teams 1. PRISM teams and Crisis House teams include, but are not limited to: i. Peer Administrators/Managers ii. Peer Supervisors iii. Peer Specialists (including Family Specialists and Parent Partners) 2. “Team” refers to a set of peers that work in a coordinated fashion in order to achieve a common goal: to effectively integrate mental health, health, substance abuse and other services in order to support people in their personal journey toward recovery. “Team” does not presuppose that all team members are supervised by the same person. Creative modes of coordination and accountability are encouraged, such as sub-contracting with other peer-run programs as the need arises. B. Program Element Set Two: Outreach Team members conduct outreach and engagement activities to a broad range of entities to ensure multiple points of entry for uninsured persons, including but not limited to: 1. County Jails 2. Emergency Departments 3. Faith-based communities 4. Family groups ATTACHMENT H Innovations Plan – Detailed Description of Integrated Peer-Run Model County of Los Angeles – Department of Mental Health 5. Parent groups 6. Peer-run programs 7. Self-help groups 8. Urgent Care Centers C. Program Element Set Three: Capacities Both strategies will include the following program elements (capacities): 1. Ability to sustain trusting reciprocal relationships with peers; 2. Capacity to link to and secure desired services within time constraints; 3. Willingness to advocate for peers, including advocating to obtain free services and/or appropriate assessments for individuals seeking professional services; 4. Experience in ways to enhance health, including but not limited to preparing nutritious food, participating in appropriate exercise; 5. Demonstrated knowledge of and linkage to self-help services; 6. Openness to spiritual beliefs and practices; 7. Experience with supervising peers. D. Differences: There are two key differences between PRISM and the Peer-Run Crisis House strategies. 1. PRISM: a. Will include the capacity to assist peers in finding housing, including collaborative housing if preferred; and the ability to provide volunteer opportunities and support peers in finding jobs in the community. b. Will dedicate a specific amount of funding to serve peers being released from jails in Los Angeles County. 2. Alternative Peer-Run Crisis House Intends to provide a safe and healing environment for people to move through their psychiatric distress in a relatively brief time (up to 15 days) and then engage in further services, if so desired, which might include referral to the PRISM team. VII. Barriers to Implementation A. Finding and training peer staff quickly enough is one barrier to successful implementation. However, this barrier can be overcome by establishing a good connection with programs that offer trainings for peer so that they inform their graduates about these strategies and the kinds of jobs available. B. Overcoming resistance on the part of some people to referring consumers to consumer-run programs. In part, this can be resolved through effective communication, coordination, organizational agreements, and County support on the front end of implementation. In addition, service providers will probably feel ATTACHMENT H Innovations Plan – Detailed Description of Integrated Peer-Run Model County of Los Angeles – Department of Mental Health the pressure of referring the uninsured to available services, as needs continue to rise. VIII. Principles, Values, Standards A. Peer specialists in a peer-run model will be responsible for designing and administering programs and securing services. B. Safety concerns will be addressed in both training and supervision of the peer specialists who work in this model. C. The peer-run model is consumer-driven and focused on developing trusting relationships with peers that support and enhance recovery. D. The systems-level transformation will be the successful integration of mental health, health and substance abuse interventions within the context of a peer-run model that is both creative and cost-effective. IX. Outcomes A. Peer Wellness Individual Outcomes: 1. Subjective measurements of increase in self-esteem and reduction of internalized stigma; 2. Objective measurements of ways in which peers are now able to live in the community in a productive and healthy manner: housing, work or meaningful activity of their choice, reduction of incidents of incarceration or hospitalization. B. System-Level Outcomes 1. Ability to integrate mental health, physical health, and substance abuse service via peer-run strategies. 2. Availability of a peer-run alternative crisis with the public mental health system. 3. A collaborative structure that enables the coordination of multiple forms of peer supports. 4. Measurement of the number of uninsured adults in both strategies who qualified for and are receiving benefits; 5. Measurement of the degree to which uninsured adults in both strategies are accessing mental health, physical health, and/or substance abuse services in a cost-effective manner; 6. Evaluation of the perception of peer-run programs in the public mental health system in Los Angeles County before and after the implementation of the Innovative Peer-Run Model. 7. Leverage of non-DMH resources from peer-based networks such as donated professional services, food, meeting space, etc. X. Projected costs ATTACHMENT H Innovations Plan – Detailed Description of Integrated Peer-Run Model County of Los Angeles – Department of Mental Health The attached budget describes the cost for the Integrated Peer-Run Model. 1. PRISM will serve 300 uninsured people per year at a cost of $1,460,000—or a total cost of $2,920,000 for two years. 2. The Alternative Peer-Run Crisis House will serve 216 uninsured people per year at a cost of $975,000 per year—or a total cost of $1,950,000 for two years. XI. Implementation Timeline Timeframe Activities Jan 2010 Estimated Plan Approval from CA Dept of Mental Health Feb – Apr 2010 Competitive Bidding Process May – July 2010 Contract Negotiations, Board Approval and Awarding of Contracts Aug – Oct 2010 Start up and Staffing of Peer-Run Models Training of culturally diverse staff in resources, including multiple self-help peer-run resources, team building, reporting methods and safety issues with input from mental health professionals and consultants to this model Nov 1, 2010 1st Quarterly Formative Evaluation and Reporting Presentation of training materials and report on methods for addressing any barriers to developing links to integrating health, mental health and substance abuse services Nov 2010 – Jan 2011 Outreach and Engagement Provision of training and consultation on jail linkages as well as community engagement with ongoing feedback to PRISM and the crisis houses on outcomes Feb 1, 2011 2nd Quarterly Formative Evaluation and Reporting Report on outcome measures Summary of challenges and successes with regard to creative use of peer specialists (people in recovery, family members, parent partners) in integrating health, mental health and substance abuse services in a culturally competent manner Feb – May 2011 Integrated Peer-Run Services Provided Adjustments to strategies as needed with ongoing training and consultation on scope of peer support and cultural competency with ongoing feedback to PRISM and the crisis houses on outcomes June 1, 2011 3rd Quarterly Formative Evaluation and Reporting Report on outcome measures and use of peer specialists as team members, including any supervisory or administrative issues that have been addressed and resolved in addressing crises and integrating health, mental health and substance abuse services June 2011 – Aug 2012 Integrated Peer-Run Services Provided Adjustment to strategies as needed with ongoing training and ATTACHMENT H Innovations Plan – Detailed Description of Integrated Peer-Run Model County of Los Angeles – Department of Mental Health consultation on scope of peer support and cultural competency as well as ongoing feedback to PRISM and the crisis houses on outcomes Sept – Dec 2012 Summative Evaluation/Final Report Report on Outcome measures Summary of challenges and successes with regard to staffing, supervision and administration peer-run crisis houses as an alternative to hospitalization and PRISM as a client-driven peer-run approach to the integration of health, mental health and substance abuse services Share results and learnings with various local, state and national audiences. ATTACHMENT J Innovations Plan – Summary of Comments from Posted Public Comment Period and Public Hearing (October 20-November 19, 2009) County of Los Angeles – Department of Mental Health A Mental Health Commission Public Hearing was held on November 19, 2009 regarding the County of Los Angeles Department of Mental Health Innovations Plan. The Mental Health Commission Chair, Jerry Lubin, and Department of Mental Health Staff responsible for the Plan were introduced to the stakeholders. The facilitator, Rigo Rodriguez, informed the stakeholders of their purpose and role regarding the Public Hearing process. Mr. Rodriguez explained to the stakeholders that they will hear presentations on the Innovation Plan including a summary of the planning process, model descriptions, evaluation plans and budget estimates. Each table at the hearing participated by submitting verbal or written questions, comments, concerns, and suggestions regarding the Plan. All comments were audio recorded and a typed transcriber was additionally employed for accuracy. A comprehensive record of the questions, comments, and concerns was subsequently developed. The following is a summary and analysis of substantive questions, comments, and suggestions that include translations from our Korean and Spanish constituents: Comments/Questions related to the Numbers Served and the Budget Several questions were raised regarding the Innovations Plan’s estimates of the numbers served and the estimated costs in the budget. Based on the comments received, LAC-DMH increased the estimates for numbers served to include those reached through the outreach, engagement, education, and screening efforts. LAC-DMH staff responded that in general the Innovations Plan attempted to use the broadest and most general outline for budgeted services to be provided in order to maintain a high level of flexibility for the proposals that will be submitted by agencies during the competitive bidding process. This flexibility will allow agencies the opportunity to submit proposals that are truly creative and innovative. More specifically, the costs of the models were estimated based on a combination of data regarding per client cost for outpatient services, medication costs, and other data obtained from stakeholders and subject matter experts for each model. In general, the data from the stakeholders and subject matter experts we consulted revealed a wide range of cost estimates from $600/year for physical health and $1,500/year for mental health to $4,000 per year for outpatient mental health services and $3,600/year for medication. There are models in other states that reportedly can deliver integrated services for as low as $1,150/year per person. LAC-DMH emphasized that the numbers provided in the Plan are the best estimates with the data currently available. As this is a learning grant, one aspect we will learn is how much integration of these services will cost for specific populations and where we can realistically find cost savings and leveraging. During the competitive bidding process, LAC-DMH will welcome proposals that can serve more clients at less cost than what is estimated in this Plan. ATTACHMENT J Innovations Plan – Summary of Comments from Posted Public Comment Period and Public Hearing (October 20-November 19, 2009) County of Los Angeles – Department of Mental Health Comments/Questions related to Evaluation The public expressed concerns that the $1 million reserved for evaluation in the budget was too low, and others provided suggestions for how to document the learnings. LAC-DMH explained that imbedded within each model are funds for evaluation activities such as participation in data collection and reporting. What is learned from the Innovations Plan will be documented and shared through a wide variety of means and to broad audiences, and LAC-DMH will consider the suggestions during the development of the RFS and the evaluation plan. Other comments included suggestions regarding what outcomes should be measured, indicators to use, and methods of collecting data. LAC-DMH will consider these suggestions during the development of the RFS. Comments/Questions related to the Integration Models Many comments and questions concerned specific program aspects of the models and their implementation. For example, there were questions about how oversight and accountability of medical services will work, how the mobile teams would cover the whole county, how American Indian healers would be credentialed, and how many peers would be employed and paid. LAC-DMH responded that many of these questions concern the implementation aspects of the plan and cannot be answered until the RFS’s are written and receive responses. The concerns and questions raised will be revisited during the RFS development. Since virtually all of these services will be contracted out, those proposals that will be successful are those that integrate care the best, have the best outcomes measurements established, are the most culturally competent, and reach out to the most groups. LAC-DMH has heard the loud and clear request that whatever the implementation, the programs must decrease fragmentation, enhance community partnerships, identify the effective elements that transcend all models, be responsive to peer input, and be pragmatic, avoiding any past preconceptions or doctrines. Another common theme in the questions concerned the role of faith-based organizations in the Plan. LAC-DMH responded that faith-based organizations are included in the document; they inadvertently were not included in the public hearing’s PowerPoint presentation. Faith-based organizations are important components of the network of community-based resources, especially in the ISM models. Other questions concerned how the services provided will be accountable to consumers and consumers’ needs. LAC-DMH responded that as part of the evaluation of these models’ ability to integrate services, LAC-DMH intends to survey stakeholder groups including consumers. These surveys will be used to measure success of both service integration and health and community outcomes. LAC-DMH also intends to provide ATTACHMENT J Innovations Plan – Summary of Comments from Posted Public Comment Period and Public Hearing (October 20-November 19, 2009) County of Los Angeles – Department of Mental Health accountability for specific physical health measures such as cholesterol, weight, and blood sugar levels. Another comment concerned how the models will serve the LGBTQ population. LAC-DMH responded that LGBTQ individuals are part of the target groups, and program proposals will be expected to address their needs. Other comments included encouragement for the Plan to consider partnerships and outreach to a wide variety of other service providers and departments such as police, probation, short-term housing services, and other advocates. LAC-DMH will consider all of these suggestions during the RFS process. Some questions were in regards to the level of acuity that would be served by this model. LAC-DMH responded that it envisions that appropriate outpatient services would be directed to both acute and chronic mental health conditions of varying severity at integrated clinic sites. The program selection process will favor those proposals that provide integrated services that best meet the need for learning and the needs of the population being served. Many individuals from this population have need for onsite specialty mental health services. However, onsite availability of additional non-specialty mental health services is by no means precluded. Other questions concerned how the Integrated Peer-Run Model would assist individuals in addressing their physical health and substance abuse issues. LAC-DMH responded that the model is designed to provide linkage to the needed services provided by professionals, and funds are set-aside in the budget to purchase clinical services from fee-for-service and other qualified providers of physical health, mental health, and substance abuse services. The physical health and substance abuse services will not be provided by peers themselves. Rather, reciprocal, self-help peer services can motivate, reinforce, and encourage activities that improve mental health, physical health and recovery from substance abuse. Additional questions asked why UREP communities were differentiated for services, and if Caucasians could receive services under these models. LAC-DMH responded that since UREP groups were one of the three focal populations identified by the Plan, each community-designed ISM is designed with a mix of services defined by each ethnic community that is currently difficult for the UREP group to access. These services are likely to be beneficial to these specific populations. Moreover, the goal of the ISM is to learn whether non-traditional resources from ethnic communities can complement formal clinical services to improve quality of care and better outcomes for UREP families. However, there is no specific individual racial requirement in order to receive such services. ATTACHMENT J Innovations Plan – Summary of Comments from Posted Public Comment Period and Public Hearing (October 20-November 19, 2009) County of Los Angeles – Department of Mental Health Comments/Questions related to Operations The public asked several questions related to the operations and implementation of the Plan. For example, one person wanted to know if previous services that were funded would be incorporated into the Innovations services. LAC-DMH responded that the Innovations funds will be used for this particular set of models, so they will not fund programs that are part of the other plans. Hopefully the state economy will improve, and more MHSA funding will be available for other services as well. Another question concerned the timing of implementation, to which LAC-DMH responded that the expectation was to implement these programs beginning August 2010. Other questions were related to the RFS process itself. For example, do applicants have to limit themselves to applying for just one model or can they apply to more? LAC-DMH responded that the models must be tested separately from one another, but a single organization could apply for more than one grant, each possibly from a separate model. However, each approved program grant must be implemented separately as the purpose of the plan is to test the distinctive effectiveness of each model. Mixing the models within a given program would preclude the accomplishment of this purpose. Another concern was raised regarding the complexity of integrating such large systems and the need to bring in outside experts to assist with program and transition planning. It was suggested that more time be allotted for start-up and planning so that appropriate attention can be paid to the mutual responsibilities of these previously independent systems and how linkages between them will actually work. LAC-DMH shared this concern and responded that the purpose of INN is to identify through careful evaluation those elements that should be adopted within larger systems. The results of INN will guide use in further system evolution through new program designs, and progress will be closely tracked and monitored. One question raised was whether providers would be excluded from participating if they only integrated mental health and primary care services or if they did not employ peer staff. LAC-DMH responded that the successful programs must integrate mental health, physical health and substance abuse services. The employment of peer staff is strongly encouraged. Lastly, other concerns were raised regarding attempts to follow particular doctrines or advocate for certain political views through this Plan (such as socialized medicine). LAC-DMH responded that the Innovations Plan design is pragmatic and is not based upon any past preconceptions or doctrines. The learning elements can be used in a variety of payor models and programs in the future. ATTACHMENT J Innovations Plan – Summary of Comments from Posted Public Comment Period and Public Hearing (October 20-November 19, 2009) County of Los Angeles – Department of Mental Health Comments in Support of Innovations Plan During the public comment period and the public hearing, LAC-DMH received many positive comments in support of the Innovations Plan. Of particular note were those from public participants of Native American, Asian Pacific Islander, and Consumer communities. For example, the Native American speakers frequently expressed their appreciation for the Community-Designed ISM that will explore how to incorporate Native American healers into the mental health system. Among other things, they said it would allow greater access to services that are congruent with their cultural and spiritual beliefs, and it could provide a replicable model for many other groups in addition to Native Americans. Several members of the Asian Pacific Islander community shared their enthusiasm for the Community-Designed ISM that will make wellness centers that are API-focused available to them. Many consumers also expressed support for LAC-DMH’s plan to have peer-run programs as part of this Innovations Plan)* * Appendix B: The Novation Motivation™ Model – Comprehensive Outline and Theoretical Framework * **Supporting Evidence:** > *(N’OVATION MOTIVATION BY OCEAN DURAN 2012 Emphasis: “OceanREmixED N’Mocean” Purpose(s): understanding the ecology of procedures produced through the NRM (natural resource management) establishments of cooperative ecosystems and remonstrating the theoretical ontology coherent to the doctrine for OceansOntology101 by design methods. ________________________________________________________________ the Healing “ART” (ARK~aTEXTure’) by Ographer Ocean Duran The various job cycles conducive to my “higher” learning in respects for remedial implications on the subjects of economics and entertainment, begins my artistic mission with research and development. By first segmenting the markets, the commodity proves a valuable effort through experiencing a gain by how I can utilize my own processes which incorporate my ideals to identify truths of the matter and how it relates to me. With provisions to the “greater” picture, my practices are consistently rehearsed in reflection to how I can visually manage “how” to create a resolution. Taking progressive measures precedent over long term goals, I have acquired short term goal structures in the production process and find that I have ethically applied proper work and business “ethics”. What this establishes is the formation of how to situate my “talents” as a skill. Therefore, allowing room for entrepreneurial goals to build on, the framework “design” is a formational placement in which I utilize my visionary management practices as though I utilize my artistic talents. Program Planning Model 2012 Ocean Duran Pre-App created for Project Assessment to his business models and like minded designs to distinguish performance/ artistic value and business model structures. Final Evaluation is proofed by mission statements according to performance and career field, production value and encourages human capital for a better “quality of living”. As a Professional Choreographer in the Entertainment business, Ocean Duran utilizes his understandings of basic business documents in which he is able to relate his ideas of performance structure and production values. However, performance of what I intend from this document relies on quality and my own ability as a creative and individual artist to provide for correlating show venues, in which performance based communities apply their ideas for educating an audience in which the arts and entertainment allow for the means to produce a show accordingly to the model design. Proper artistic expressions of its producer’s ideas for the sole purpose of growth in business practices which allow for “outside the box” thinking and encourage his community for resourcefully preserving the culture by portraying it in a respected means for both the arts and community. And the ideas and objectives expressed here do not reflect the potential of what can actually be created to meet the production model design based off of the rider information about the show, and an in person interview is required for approval of the show… Introduction: I. Artistic provisionary practices and business relations. N’ovation Motivation. The “Media Arts” personify reality based structured design assessments, supporting the creation of applicable business practices as an innovative means to what is motivationally fueled! A. Environmental Management B. Interweaving cultures for developing new personal network relations C. Identifying key elements for project work load processes within media components. D. Conceptualizing micro-level objectives that support for new macro-level work flow designs. Qualitative Production Model Performers Paramount is a formulation of strategies that allow for its production process to provide for performance, providing support for the arts and entertainment to produce outreach programs. Its structure implies that each component involved is also a performer by how it is able to facilitate within the production process. In doing so, this event qualifies a showcase performance remedial to the lack of economic productivity and stimulates the environment to also perform. The final outcome is a reprocess of economic value that practices and involves the use of resources and networking. Within the community of arts and entertainment, programs are therefore developed for the purpose of outreaching to surrounding communities for involvement and support for financial requirements coherent to grant funding. Resourcing; Networking Resources OceansOntology101 allows for correlating activities in which the purpose for “Resourcing; Networking Resources applies directly to my teachings about “healing”. In this design, I show and help you understand how to apply foundational philosophy that people these days join groups of meditation and gym activities for self healing. In this same light, I am able to relate business, and the body for success according to the business models • Mission Statements, • Needs Assessments, • Impact Assessments, • Company Identity, Business Objectives. ^Methods/Tools^ To produce for consumer market Methods/ Tools are designed to “serve” the consumer based on what has already been established. By first producing a product that they are interested in, the business model. II. Key Factors A. Administering componential awareness which acknowledge formational activity. B. Integrating Operative values that help define the gain in human capital. C. Support for detailing the preferences to define methods for the investment to a “quality of living”. Team Qualifying Productions The Performers Paramount comprises of a skillful team with the innate ability to redefine the entertainment community. These organizations qualify the use of their own business relations within this community and exemplify what it means to be a polished performer. The Artistic Direction is lead by Choreographer Ocean Duran who facilitates the team’s formation by each of their strengths, and to meet the productions requirements accordingly, each organization is propositioned to perform within their own business practices. This establishment is provisionary to the events process and in reflection to the Performers Paramount design, promising a strong foundation to its production. I m p a c t A s s e s s m e n t p r o d u c t • Remonstration for Streamlining the Environmental Impact and implicate (the) stimulate procedures. ~N’fluentiALL impact that in-turn motivates us, When we get others to move all~together for the influential impact that in-turn motivates us. Finding that production and performance both offer movement, therefore To contribute to this “action”, brings motivational factors used in momentum and Production can be designed for qualitative results Performance can be designed for qualitative results. Persona allows for engaging… III. Infrastructure and design awareness A. Community involvement as a co-operative work flow, allows for executive positions to create the functional productivity on behalf of community support. . B. Project objectives allow for media and procedural relations that establish capital gains to constitute personal core values. 1, Media Relations, within his professional business practice is a product that skillfully applies his talents for visually managing his expressive works. His perfection is his product that comprises of satisfying the customer while attempting to fulfill his own standards and expectations of quality. Sought after by high profile celebrities because of his experience in working with big names. 2, Event Marketing and Promotions. Experiences within the industry have leaded this business owner to understand the market by how he can also provide for it and does not overlook the fine details involved. By creating the element which might not be currently available, his creative process correlates with his profession, allowing him to produce a product based on its availability for product placement. 3… Production Management. As a respected and well known leader within the entertainment community, she understands through experiences how professional careers can be developed and acquired in the entertainment business. Therefore, she is able to develop her talents and skills through its process. By utilizing the process to her advantage, she is plentiful in her experiences of production planning and is unequivocally matched in her profession to develop a production accordingly for her clients. Choreographer Ocean Duran. His professional career as a choreographer has allowed him to work with some of the biggest companies in the business such as Clearchannel Worldwide and Millennium Dance Complex. Based on the implications of what can be created to accessorize product So that it is able to reach 1. a further market appeal. By providing the core product of a business with other tangible sales or serviceable features, you create between you and the client a level of purpose to enhance company practices, while morally exemplifying the process of sales ethics which standardized businesses, however, with those tangible features do you become more value to the company for educating your role to be qualified in it’s products… ~OceansOntology101 “technique and work ethics by creating the core production so that it is able to continue to grow. “ Growth occurs based on the implications of what can be created to accessorize ~N’fluentiALL impact that in-turn motivates us, When we get others to move all~together for the influential impact that in-turn motivates us IV. Growth development within performance A. Assimilation (practices that re-evaluate the educating process) Producing promotional and practical strategies to create a plan for educative practices. B. Accommodation (Individual artist goals) Define the process or procedure by first recognizing a situation that allows for production, process and systematic involvement. C. Compositional propositions that evolve a performer require his personal objectives are invested in his own growth. • Applicant Statement: Influential means within the community of the arts network the community so that it streamlines the process of creating a production into a fully functional system. The ability to educate the process of what is forged into a systematic means relies on how we can outsource external influences. This consists of innovative resources such as social class, culture, reference groups, and family and friends to help create the system so that it produces by reaching out to other venues. Subjects; 1. Creation Application 2. Growth in the Arts and Entertainment 3. Reaching for the stars to shine 4. Quality Design Acknowledgment Activities Finding that production and performance both offer movement , therefore to contribute to this “action”, brings motivational factors used in momentum and Production can be designed for qualitative results Performance can be designed for qualitative results. Persona allows for engaging… • Outcomes Keeping practice to quality production, and giving attention to other aspects that help define the vast areas of quality. Performance can be graded on how well something can provide satisfactory results… Targets or Objectives Seen to have a beneficial gain at certain levels of skills while an expectation must meet a required demand. Performance allows for short term goals Indicators because of the performance ability to match or exceed itself. Expectations are also defined by the time quality opposite of performance. V. Provisionary management using media and the arts for progressive measures to introduce new foundational production designs A. Introduces a person to the moral directives which implicate both Scientific and Design Method practices. B. Research and development within the arts implore the ability to grow as a means for personal assessments in relation to media preferences. C. Knowledge of each type of media requires targeting disciplined learning environments for media communications. D. Media projects develop applicable, unsought foundational organizational tools. E. Developmental Stages allow for steady growth and interaction. Sound Trax 101 Composition of RPM (Rhythm Patterns N’Mocean) Situational Events recalling chronological events directing M’ocean for evidential outcomes. Usually as a result deriving from progressive structure, we find first movement or M’ocean. What acts as a “medium” or connecting component can be described as a “pattern”. This “pattern” is recognized because we can find it to conform to our own personal methods to successfully achieve principals in which we conduct our lives. Principality finds truth within this pattern because naturally we develop techniques that we utilize as tools in development such as school or work place. Rhythm is most noticeable when we are finding ourselves to be in “sync” with either past experiences or by environmental impact. Through rhythmic movement we discover a “force” or “energy” that seems to encompass our lifestyles. Understanding rhythm is a form of wisdom that one can easily understand when they experience a situation that they have been able to surpass by observation. Methods/Tools Business and marketable concepts to produce for consumer markets are designed to “serve” the consumer based on what has already been established. By first producing a product that they are interested in, the business model allows for continuing the relations. Therefore, what is produced after the initial product is an accessory to the product so that it is able to reach a further market appeal. Timeline When you will measure the target(s) or objective(s) What we want from a core products or purchase is seen in movement, when the object is “still” we then “act” to therefore involve the customer. The goal here is to see a Vision which provides for movement. (all that can be structured upon a firm foundation by a third reorders the design because it streamlines the flow for movement) VI. Personal Directives identify strengths and weakness to assess the goal and objectives are naturally created for procurement. A. Human capital gain and increase. B. Learning an innate ability to adapt in a situation by propositioning artistic methods as a practical work flow. Who Evaluating a quality product is a process involving proper sales technique and work ethics by creating the core production so that it is able to continue to grow. Growth occurs based on the so that the evaluation process is a reprocess in which implications of what can be created to accessorize the core evaluating the concept occurs. Observation of applicable situations in which experiencing an event through personal experience is viewed first as an involvement to help remedy that situation. Drafting this situation derives from improvisation based on teaching methods expressed from OceansOntology101 “The Sound Doctrine”. Outcomes: 1. System information…- Keeping an open mind in possibilities. “truth is relative” Strategic Implements- Recognizing variables and formation… Placements. 1. Systematic Resourcing, Foundation Exemplification- • Visual Management refers to observations relating to previous work indirectly seen to fulfill formational variables in the present current proposition. 2. Pre-defining available measures- • Placement and redefining what is observed in accordance and recognized through a type of language or tongue. An occurrence which derives from what has happened up to the current point in time. 1. Critical Resource Functionality-(Philosophy of the “biz”) • *Strategic Implements-Entertainment (choreography), Funding (resources) re-establishment of learning and experiencing growth in “real time”. • *Systematic Resourcing-1. Performance Production. 2 Resourcing process to help remedy a cause. • *Predefining available Measure. 1. Counter-acting around the topic of recession. (performance) “Performers Paramount” (standard expectations) “1. Resourcing 2. Education” (product benefits) “production and identifying key roles qualifying proper placement of each position for talent and crew to define qualitative characteristics of the Performers Paramount.” (beneficial life experience) “Ographer Ocean Duran”-experience; Reaction Realism Relative “expressions need to be themselves” The true success from contributing ideas comes from organizing information and implementing a strategy to the work order and streamlining it to perceive an actual base structure already there. Therefore laying foundations, becomes irrelevant until the “situational order” becomes naturally fluent and flows as a streamlined order so that we can implicate just how “relevant” a foundation must be. (Structured Components) *Observations created, become a variant of what is already there, Allotment for new directions reflecting the current formation, Establishing the “core structure” based on what surrounds the central focus of the current greater formation.” (observed compositions) Existence does not conform by chance, rather it lives based on the notion of how it relates in purpose to how it lives “now” in its meaning or by what it stands next too so that it can relate to what it is being defined. Applying established Contributions as a capital gain. (questions are based on a funding resource, allowing for propositional reply and answers to conform accordingly) 1. Describe the artistic innovation project for which you are seeking funding. Be as specific as possible by identifying the collaborators, resources and timeline required to implement your proposed project (Max 500 words). You will also include Bios of Key Project Collaborators here, not to exceed one (1) page each 2. Explain how your artistic innovation project is “pushing the envelope” for you or your artistic practice, and how it might influence your work in the future (Max 300 words). 3. Provide a brief statement on your artistic practice and the nature of your work (Max 200 words). You will also include your Artist’s Resume here, not to exceed two (2) pages. Conclusion: Reply 1. -Observations created become a variant of what is already there. Allotment for new directions reflects by establishing the “core structure”. Critical Resource functionality (philosophy of the “biz”) strategically implements experiences in the Entertainment field for Choreography and Funding through established resources in “real time” provide for growth based on the moral procurement that “expressions need to be themselves”. These variables are already there because of their own purpose to establish another form of work flow. Allowing for these observations to provide for variants as a means to “grow”, establish the “core structure”. Reply 2 -Therefore, existence does not conform by chance, rather it lives based on the notion of how it relates in purpose to how it lives “now” in its meaning or by how it comes to stand. This systematic resourcing of the performance production and resourcing process to help remedy a cause, is a basis on what surrounds the centralized focus of the current, greater formation produced naturally for remedial needs or innovation to the standard. These predefined measures therefore surface around the topic that may suit, such as a recession state due to a malnutrition system, and allows for a base structure to become apparent through streamlining a work flow order and finding weaknesses. Thus, setting foundations on the old becomes irrelevant until the “situational order” allows it to work in line with what relates it to a firmer foundation and sits within a structure that connects. Reply 3 -PERFORMERS PARAMOUNT; Naturally the flow is fluent and streamlined so that it implicates the relevant foundation is in its own working order for movement. These beneficial “products” identify key roles that qualify proper placement and with qualitative resolve due to it’s structured components, in essence, the experience is a “beneficially life experience” which helps to define a need for a qualifying composition consisting of many types of variables that provide an innovative remedy for the cause. -REACHING FOR THE STARS; Ographer Ocean Duran brings forth his strengths, talents and skills to provide for a means to provide work and job opportunities for talent and industry professionals. As the creator and founder of the Performers Paramount and Reaching for the Stars outreach program, his plan for providing performances becomes a streamlined work flow order which embraces a more incorporated idea that comes to exist by the moral definition of the Performers Paramount. Thereby creating an outreach program (known as “Reaching for the Stars) based on the foundational production, relative ethical practices for what establishes an ongoing process for growth becomes the remedial component to what lacks in the present recession, directional movement. Introduction- anything introduced, brought into use, knowledge or fashion Sentence Structure; (Emphasis)(Program)(How to)(Answer)(Major Accomplishments)(Needs Statement)(Support History)(Approach/ Core)(Final Reporting/ Placement). EMPHASIS: Program 1:idea Program 2: correlation Program 3:production Support: program documents Approach: exemplification Final Reporting: design methods DIRECTIVES: -serving to point direction, of or relating too. PROVISIONS: -A preparatory action or measure. Stipulation/ qualification. Provisionary Management: Lingo, Location, Lending. OUTLINE 1 Systematic Implements Systematic observations of formational elements which by its design for progression in the learning curve. Type cast and applies elemental structure according to artistic plans. Formulate business definition by documenting the artistic structure for each project coherent to the plan objectives Identifying the process for production development Qualitative expectations for artistic direction, helping to structuring new development. Establishing other add-ons to accessorize the core features. Systematic provisions correlating product designs from industry to industry. The development of the product identity for market approach and resource management with defined features. To develop growth from this type of learning and application, foundations relative to correlating activities surface as the focal point to our individual learning pattern. While performing our own set of values that include concepts, principals and morale, the designs formation is seen to replicate the artistic mission so that the marketing and production plans provide for foundational exemplifications. The bones to the success of this event consist of industry performers, and how they can relay the vision and message. So by involving the community to create opportunities that forecast future outcomes (which provide work for their clients) and by allowing for growth, the potential for the structure of this plan is just the stepping stone for many other venues which interconnect in qualitative designs. Contributions set forth for the show will exist based on the notion that each performer and crew member are all contributing to the show so that growth occurs, and a resourceful networking process creates for opportunities. This event comprises of the foundations in which opportunities are formed in the community, as an “ins” to produce and to actively be involved in developing their own careers and business goals. Functionally, this event was created to correlate the foundation structure to the production process. Thus, the events production stages and mechanics reflect “growth propositions” which accessorize the event so out reach programs can be developed and pursued. Program examples of outsourcing documents to conduct standard business practices. Resources (Revenue – actual and in-kind) Inputs (Expenses – actual and in-kind) Activities How, or, the methods and actions undertaken to achieve the outcomes Outcomes The benefits, changes or improvements that will result from your implemented program or project Targets / Objectives Projected level of success or result you hope to achieve 2 Systematic resourcing-Foundational exemplifications Internal Formations consist of intellectual forecasting and will be the starting point for the production to begin the research to develop for … External formation is a composition of elemental formations in which by streamlining various external programs, can we discover the core structure as the infrastructure present in universal connection. Therefore, we are able to see both micro and macro purposeful to streamline the contrasts… and with the ability to acknowledge framework. By relating the production plan as a means to simultaneously fulfill the marketing plan, the artistic mission clarifies how the business plan will be set forth. The transitional aspects from industry to industry therefore begin to define its own foundation. Producing the opportunities to economically adhere too for forecasting future outcomes, the idea to create for career development and financial gain are brought forth within the transitional aspects so that the production can be identified within the business plan objectives as the artistic mission. Each business relies on product identity, whether that is a representation of the company such as an artistic quality of the company’s identity, or so that it provides a service to the community to which it associates with. Thereby identifying the community as a means to also help characterize its members, within the arts and entertainment community, careers are sought after by what they are able to pursue and grow into as. From there, they can then begin to train and perfect their skills and talents as a career. The process of what can be accomplished by restructuring the micro levels of the arts and entertainment community and its needs are accomplished by what can be produced for the community, simply by pulling from their own resources and producing within the community network. By producing from within the community and its network, new business relations are considered by how it is able to relate or networked within the community, creating a place for it in the production. What results from a production that involves its community is a process that can be formed as the means to service the community so that it engages other sources, not usually associated to it. What is accomplished in the production process, qualifies for creating the production, based on the members who characterize the community by their own identity. A production that adheres to the strengths of each identity is a reprocess which allows for a variety and number of ways to identify the community. This is produced by creating it with the intentions of utilizing the community so that the needs are satisfied and met. The result is a networking resource of various creative outlets which allow for new relations and connections to be produced so that growth occurs on both micro and macro levels. In short, what can actively be involved within the production process will forecast the future opportunities made available. This is based on the implications relative to the success of the production, so that the resolution to what is needed does not stop just there, but provides for economical worth as well. Some researchers combine SPEECH ACTS theory with PROBABILITY theory to determine the likelihood of someone behaving in an ideal fashion “Matching the work in a systematic fashion” Whenever you make an utterance your saying to someone about something in a particular place and time for a particular reason. Humans use language across a broad range of situations called “CONTEXTS” and are classified according to a number of characteristics. (understanding your communication platform; Linguistics or language understood between you and your audience.) 3 Predefining available measures Procedures, Practice, Performance Community and Core Audience Administrative Information Artistic/ Executive Directors 1. COMPANY BACKGROUND Producing innovative outcomes reliant only on the perfect remixing of cultures stimulating positive growth by comparing our own core or foundations to the products core from which we acquire skills. We evolve our own quality by being motivated based on the value of self worth. By educating our environment, we are an invaluable provision and asset for the foundations of what life has given to us. 2. IDENTIFICATION OF NEEDS & OPPORTUNITY To bring forth core philosophical strategies and movement within that has acquired the applicable skills to “know how to move it on out”. 3. PROPOSED SERVICES Our being doesn’t “desire” the “hire” and what comes through, is a specialized ability correlative to the educative up-bringing as an innovative and motivative Muse! 4. IMPLEMENTATION PLAN Utilizing resources as a foundational structure for financial attributes Utilizing personal resources to forecast propositional business relationships Creating a Network of resources as a Contribution Develop times and natural orders Find Research Industrialize Profession Foundations Philosophies 1. Tackling obstacles by situational development and creating it as a “strategic opportunity” to create a list of potential sponsors and resources. 2. Quality Leadership by the performers and Sponsors involved are contributing to the performance. Based on the notion that the concept of the showcase provides each element as its own identity. Therefore, competition of any peer group is negating because of how they are to be defined as a performer in the showcase line up. 3. Utilizing natural order as an ethical foundation. Because of this diverse unification of such an industry of arts and entertainment, each contribution by the sponsorship network gives the appeal factor for each company to provide their best representation which identifies them already in the industry as a respectful business. 4. Strategic communication tactics. The success of the event relies on the basis of communication and quality talent matched by artistic appeal and the ability for growth. This allows for each contributor advertisement or a table in the show to provide for the target audience a direction for their talents and services to grow by creating educational programs. What is produced in the networking and production process for the event showcase is a community of industry professionals who have contributed their company identity for the showcase so that they establish a means to forecast future opportunities brought forth by the production and marketing plan design of the event showcase.)* * Appendix C: Glossary of Key Terms (LACDMH and Novation Motivation™) * **Supporting Evidence:** > *(Combines terms from LAbizPlan.txt – Mental Health Innovation and Human Capital Study Guide – Glossary, like “UREP,” “MHSA,” “Integrated Care,” “Peer Support,” with unique conceptual terms from LAbizPlan2.txt such as “Systematic Resourcing,” “Performers Paramount,” “OceansOntology101,” “Directional Movement,” “Qualitative Resolve,” “NRM,” “ARK~aTEXTure’.”)* * Appendix D: Supporting Research and Literature (Placeholder) * **Supporting Evidence:** > *(LA Integrated Health Models & Innovation.These sources collectively describe an innovative initiative in Los Angeles County to integrate mental health, physical health, and substance abuse services, with a specific focus on serving underserved and underrepresented populations like the uninsured, homeless, and various ethnic groups. The plan outlines four distinct models (Integrated Clinic, Integrated Mobile Health Team, Community-Designed Integrated Service Management, and Integrated Peer-Run), each designed to address fragmentation and improve outcomes through approaches like community collaboration, culturally competent care, peer support, and leveraging existing resources. Concurrently, the concepts presented by Ocean Duran, while rooted in artistic production, offer a framework for understanding innovation, process, and the value of lived experience in achieving qualitative results and building effective systems through collaboration and understanding individual and environmental elements. ——————————————————————————– The Power of Lived Experience in Mental Healthcare Based on the provided sources and our conversation history, lived experience is consistently highlighted as a profoundly valuable resource and a core component in efforts to innovate and improve mental health service delivery, particularly for underserved populations in Los Angeles County [1-15]. In the context of the LAC-DMH MHSA Innovations Plan, “lived experience” refers to the personal understanding and knowledge gained by individuals who have directly experienced mental health challenges, homelessness, or faced the barriers within the existing service system as members of underserved populations [1-7, 9-15]. This also extends to the experiences of families, parents, and caregivers who have supported individuals navigating these challenges [1, 3, 16-22]. The value of lived experience is recognized for several key reasons: • Informing Service Design and Delivery: The LAC-DMH plan was developed through an extensive community participation process that explicitly included consumers, families, parents, and caregivers in formal decision-making roles [1, 3, 13, 16-21, 23]. Their input, along with that from groups like the UREP subcommittees [1, 13, 16, 17, 19-27] and the Homeless Advisory Council [28, 29], is seen as essential for shaping innovative strategies that are truly responsive to community needs and values [1, 3, 13, 16, 19, 28, 30]. • Understanding System Fragmentation: Individuals with lived experience have firsthand knowledge of navigating the fragmented system of mental health, physical health, and substance abuse services [10, 19, 31, 32]. Their experiences provide a practical, ground-level understanding of where the system breaks down – such as disconnections between providers, communication failures, and barriers related to funding streams or referrals [10, 19, 31-35]. This awareness is considered vital for designing solutions that effectively address fragmentation and improve the system’s functionality from a client’s perspective [10, 11, 19, 31, 32]. • Enhancing Peer Support Roles: The concept of utilizing the unique insights and empathy gained through personal experience is central to the role of peers (also referred to as peer specialists, advocates, or “peer bridgers”) [3, 5, 10, 11, 16, 21, 22, 31, 36-38]. Peers with lived experience are uniquely positioned to provide support, information, and encouragement to others facing similar challenges [3, 5, 10, 11, 16, 21, 22, 31, 36-38]. The plan specifically seeks to expand possibilities for peer staffing, including in administration and supervision roles [13]. • Driving Integrated Care Models: Lived experience is a foundational element of several innovative models proposed in the plan: ◦ The Integrated Peer-Run Model is explicitly designed to be developed and run by people with lived experience, offering client-driven alternatives to traditional services like Peer-Run Integrated Services Management (PRISM) and Peer-Run Crisis Houses [5, 7, 10, 13, 16, 19, 22, 27, 39, 40]. ◦ The Community-Designed Integrated Service Management (ISM) Model leverages the “collective wisdom” of UREP communities [13, 24] and utilizes culturally competent “service integrators,” including trained peers grounded in ethnic communities [13, 19]. ◦ The Integrated Mobile Health Team Model, which serves homeless individuals, includes peer/family/parent advocates as part of its multidisciplinary team [13, 16, 19, 21, 22]. • Focusing on Meaningful Outcomes: Lived experience helps define what “better outcomes” truly mean for individuals navigating recovery and seeking stability [10, 19, 31, 41]. For the homeless population, for example, achieving and maintaining housing stability is a clear, tangible outcome of “directional movement” towards stability, which can be informed by the experiences of those who have successfully made that journey [10, 19, 31, 42]. This perspective can be crucial for assessing the effectiveness and impact of integrated services beyond traditional clinical metrics [10, 19, 41]. Our conversation history has specifically connected Ocean Duran’s perspective to the value of lived experience [3, 4, 10, 11, 31, 43, 44]. Although the sources don’t detail his personal history of homelessness or receiving services [4, 10], they acknowledge that his awareness of lived experience can be vital for the LAC-DMH plan [1, 3, 4, 10]. His focus on understanding processes and workflows [10, 19, 32] and the concept of “directional movement” [10, 19, 31, 42] align with the goal of overcoming system fragmentation [1, 10, 19, 32, 45] and supporting clients’ progress towards recovery and stability [10, 19, 31, 42]. Furthermore, his emphasis on utilizing individual talents and experiences [5, 10, 19, 31] and the importance of collaboration [19, 31, 46, 47] resonate strongly with the plan’s reliance on peer roles and community-designed approaches that are rooted in lived experience [1, 3, 5, 10, 13, 16, 19]. The value he places on achieving “qualitative results” and a “beneficially life experience” [19, 31, 47] reflects the human-centered outcomes that integrated care, informed by lived experience, aims to achieve [10, 19, 41]. In essence, the sources demonstrate that lived experience is not just a personal narrative, but a critical form of knowledge and a powerful asset for understanding system challenges, designing effective and culturally relevant services, and achieving meaningful outcomes in mental healthcare [1, 3, 5, 10, 11, 13-15, 19, 31, 32]. ——————————————————————————– Integrated Mental Healthcare Models for LAC-DMH Based on the provided sources and our conversation history, Integrated Care Models are a central focus of the Los Angeles County Department of Mental Health (LAC-DMH) MHSA Innovations Plan [1-6]. These models represent a strategic effort to address the significant challenge of system fragmentation in mental health, physical health, and substance abuse services within the county [1, 2, 7-10]. Fragmentation is identified as a major impediment to service quality and good outcomes [1, 2, 7, 9, 10], often resulting in incomplete or inappropriate treatment for consumers [9, 10]. The primary purpose of the entire Innovations Plan is learning, specifically to identify new practices that can increase the array of creative and effective approaches for mental health services, with the highest priority being to increase the Quality of Services, including Better Outcomes by addressing this fragmentation [1-4, 7, 11, 12]. These integrated care models are designed to specifically serve underserved populations in Los Angeles County, including the uninsured, the homeless, and Under-Represented Ethnic Populations (UREP) [1-5, 11-14]. The plan aims to improve access and overcome barriers such as stigma, mistrust, and lack of culturally and linguistically competent services that disproportionately affect these groups [15-17]. The plan proposes four distinct integrated care models [1-6], each attempting to address fragmentation and serve target populations through different approaches: • Integrated Clinic Model: This model aims to increase the quality of care and services by combining mental health, physical health, and substance abuse services in community-based sites, such as primary care clinics or mental health clinics [1-6, 8, 18-22]. Its purpose is to fully address the spectrum of needs for the uninsured, homeless, and UREP [5, 8, 18]. Key features include using a “no wrong door” approach to increase access [19, 22], providing a “home” for integrated care [22, 23], using multidisciplinary teams to coordinate care [19, 22], and embedding services in primary care settings to potentially reduce stigma [22, 23]. It also focuses on cultural competence and cost-effectiveness [22-24]. • Integrated Mobile Health Team Model: This model is primarily designed for homeless individuals, many of whom are uninsured and UREP [1-6, 25-27]. It addresses fragmentation by providing a mobile, integrated, multi-disciplinary team that delivers services directly to clients where they are located (streets, shelters, Permanent Supportive Housing – PSH) [5, 25, 26]. It utilizes a client-centered, housing-first approach with harm reduction strategies [5, 25, 26]. Innovative funding like project-based service vouchers tied to PSH units are used to ensure ongoing access to integrated support [5, 26]. • Community-Designed Integrated Service Management (ISM) Model: Explicitly focused on Under-Represented Ethnic Populations (UREP) [1-6, 28-30], this model addresses fragmentation by building on community strengths and allowing communities to define care within trusted institutions [5, 28, 29]. It promotes collaboration between formal and non-traditional providers (like faith-based organizations or community healers) and community organizations [5, 28-30]. The model uses culturally competent “service integrators,” including professionals and specially-trained peers, who are grounded in ethnic communities [5, 29, 30]. This approach is informed by the “collective wisdom” of distinct UREP subcommittees [4, 29, 31]. • Integrated Peer-Run Model: This model utilizes a peer-driven approach to identify, obtain, and coordinate physical health, mental health, and substance abuse care for uninsured adults with mental health needs [1-6, 32-34]. Programs are designed and run by people with lived experience [5, 32-34]. It includes strategies like Peer-Run Integrated Services Management (PRISM) and Alternative Peer-Run Crisis Houses, offering client-driven alternatives to traditional services or hospitalization [5, 32-34]. The model aims to reduce fragmentation through peer support and expand peer-run options, emphasizing cultural competence with peers of similar linguistic and ethnic backgrounds [5, 33]. Our conversation history highlights how the concept of lived experience, particularly navigating systems as described by Ocean Duran, provides valuable insight into the challenges of fragmentation [1, 35-41]. His focus on understanding processes and workflows relates to analyzing the points where fragmentation occurs [2, 38, 40, 42]. The idea of “directional movement” towards recovery and stability, a key theme in our discussion linked to Duran’s concepts, is precisely what these integrated models aim to facilitate by creating a smoother path through the service system [2, 40-45]. Furthermore, Duran’s emphasis on “interactivity” and “community collaboration” aligns directly with the core principles of integration and the leveraging of community strengths seen in models like the Community-Designed ISM [2, 42, 43]. The goal of achieving “qualitative results” and a “beneficially life experience” for clients, as discussed through Duran’s framework, resonates with the Innovations Plan’s aim for “better outcomes” and improved quality of life stemming from integrated care [2, 41-43, 46]. The inclusion and emphasis on the role of peers (“peer bridgers”) in the integrated models directly reflects the value placed on lived experience in both the county plan and our discussion of Duran’s perspective [1, 35-37, 40-44]. In summary, the integrated care models in the LAC-DMH Innovations Plan are strategic initiatives to combat system fragmentation [1, 2, 7-10], improve service quality and outcomes [2, 3, 5, 7, 10, 47], and increase access for underserved populations [1-5, 11-14]. By testing these varied approaches – clinic-based, mobile, community-designed, and peer-run – LAC-DMH aims to learn how to build a more connected, responsive, and ultimately more effective mental health service system [1-4, 11, 12]. ——————————————————————————– Los Angeles County Underserved Mental Health Innovations Based on the provided sources and our conversation history, underserved populations are a central focus of the Los Angeles County Department of Mental Health (LAC-DMH) MHSA Innovations Plan [1-10]. The plan prioritizes addressing the needs of these groups, who are identified as being greatly impacted by issues like decreased funding and system fragmentation [6, 8, 11-15]. The plan specifically identifies three critical populations as the primary focus for innovative strategies: • The uninsured [6, 8, 11, 12, 14, 15]. • The homeless [6, 8, 11, 12, 14, 15]. • Underrepresented Ethnic Populations (UREP) [6, 8, 11, 12, 14, 15]. The sources list the five distinct UREP subcommittees that provided crucial input: African/African-American, American Indian/Native American, Asian and Pacific Islander, Eastern European/Middle Eastern, and Latino communities [6, 8, 16-21]. Beyond these primary groups, the plan also acknowledges other sub-populations as underserved, including linguistically-isolated families/individuals, those who have not accessed services due to stigma, those who have not benefitted from or received inappropriate services, and uninsured individuals from GLBTQI, Deaf or Hard-of-Hearing, and Blind or Visually Impaired communities [6, 8, 22-27]. Families, parents, and caregivers are also considered stakeholders and target populations [1, 2, 5, 6, 8, 11, 28-32]. These underserved populations face significant challenges and barriers to accessing and benefiting from mental health services: • Fragmentation of services (mental health, physical health, substance abuse) [1, 3-6, 11-13, 15, 28, 29, 33-38]. This is highlighted as a major impediment to quality and outcomes, disproportionately affecting underserved groups [2, 5, 6, 14, 24, 33, 39-43]. • A fraying safety net due to decreased funding and a growing number of uninsured people [11-15]. • Decreased capacity to serve uninsured clients [11-15]. • Stigma surrounding mental illness is a powerful barrier, distinct from issues of cost or availability [15, 18, 22, 24, 32, 44-49]. • Mistrust and fear of treatment, racism, discrimination, and differences in language and communication, particularly for UREP members [15, 18, 32, 44, 48, 49]. • Lack of access to culturally and linguistically competent services [15, 16, 18, 23, 24, 48-52]. Formal providers haven’t always recognized or known how to tap into the inherent resources of ethnic communities [15, 18, 48, 49, 51]. • Geographic boundaries for service delivery are often incongruent with ethnic communities [15, 16, 18]. • For homeless individuals, specific challenges include lack of access to various types of healthcare, compounded by the conditions of living on the streets [15, 18, 37]. There is also a lack of dedicated funding for supportive services in permanent supportive housing [49, 52-54]. The LAC-DMH Innovations Plan was developed through extensive community participation, including the MHSA UREP subcommittees and the Homeless Advisory Council, specifically to address these issues and increase access for underserved groups [9, 11, 12, 55]. The plan proposes four integration models designed to overcome fragmentation and serve the uninsured, homeless, and UREP [10, 28, 32, 56, 57]: 1. Integrated Clinic Model: Targets the uninsured, homeless, and UREP by combining physical health, mental health, and substance abuse services in community sites [7, 10, 11, 16, 23-25, 57-60]. This aims to increase access by being in familiar locations, reduce stigma by integrating with primary care, and uses a “no wrong door” approach [10, 33, 44, 45, 57, 60-62]. Peers are included as staff [10, 53, 57, 63-66]. 2. Integrated Mobile Health Team Model: Primarily for homeless individuals (many of whom are uninsured and UREP) [3, 10, 34, 35, 67-70]. A mobile, multidisciplinary team provides integrated services where clients are located (streets, shelters, PSH) [10, 34, 61, 70]. It uses a client-centered, housing-first approach with harm reduction strategies [10, 34, 60, 61, 70, 71]. Innovative funding like project-based service vouchers tied to PSH units are used [10, 17, 61, 67, 70]. 3. Community-Designed Integrated Service Management (ISM) Model: Explicitly focuses on UREP communities [4, 10, 14, 16, 19, 21, 23, 24, 35, 36, 39, 51, 58, 60-62]. It addresses fragmentation by building on community strengths and allowing communities to define care within trusted institutions [4, 10, 14, 19, 36, 58, 60, 61]. It promotes collaboration between formal and non-traditional providers and uses culturally competent “service integrators,” including trained peers, grounded in ethnic communities [10, 14, 16, 19, 36, 39, 60, 61]. It utilizes community-designed peer-based outreach and advocacy to address barriers like stigma and linguistic isolation [10, 14, 19, 36, 39, 46, 47, 50, 55, 57, 60, 70]. 4. Integrated Peer-Run Model: Supports uninsured adults with mental health needs (including those who may be homeless and/or UREP) [10, 25, 30, 31, 51, 60, 72]. Programs are designed and run by people with lived experience (peers) [10, 14, 30, 31, 51, 72]. It includes Peer-Run Integrated Services Management (PRISM) and Alternative Peer-Run Crisis Houses as client-driven alternatives to traditional services or hospitalization [10, 14, 20, 21, 30, 31, 51, 60, 68, 72]. This model expands peer-run options and integrates peer support in coordinating care [5, 10, 14, 30-32, 52, 60, 63, 72]. These models strongly emphasize community involvement, cultural competence, and the crucial role of lived experience [1, 2, 4-6, 10, 14, 16, 18, 19, 22-24, 29-36, 39-42, 51, 55, 61, 62, 72, 73]. The “collective wisdom” of UREP subcommittees guided the Community-Designed ISM Model [10, 14, 16, 19, 32, 34, 74]. The Integrated Peer-Run Model is fundamentally based on utilizing individuals with lived experience [10, 14, 30, 31, 41, 51, 72]. Our conversation history has connected the challenges faced by underserved populations, particularly the homeless, to Ocean Duran’s perspective. His lived experience of navigating the system provides a deep understanding of its fragmentation and barriers [17, 22, 33, 41]. His focus on “directional movement” is highly relevant, as fragmentation hinders clients’ progress towards recovery and stability [33, 41, 44, 45]. The success of securing housing after homelessness is a prime example of this crucial “directional movement” [41]. Duran’s emphasis on utilizing individual talents and experiences directly supports the value placed on peer roles (“peer bridgers”) in the county plan, suggesting his perspective could inform how to effectively support others in navigating the system and achieving positive outcomes [29, 39, 41, 58, 66]. ——————————————————————————– Addressing Mental Health System Fragmentation in LA County Based on the sources and our conversation history, system fragmentation is identified as a key overarching challenge for mental health services in Los Angeles County [1, 2]. This fragmentation involves the separation of mental health, physical health, and substance abuse services [1-11]. It is explicitly considered a major impediment to service quality and good outcomes [1, 2, 6, 10, 12]. The fragmentation manifests in various ways within the service system: • Services are often located in different settings [5, 9]. • Providers work for various agencies under separate systems, supervisors, regulations, and requirements [5, 6, 9-11]. Previous multi-disciplinary teams were hindered because team members were accountable to different agencies or supervisors [5, 9]. • Clients often have separate charts and care plans [5, 9]. • There are disparate and separate funding streams [5, 9, 11, 13, 14], and identifying sustainable funding for integrated programs is a challenge [13, 14]. • There is limited capacity for communication, coordination, and sharing of information among programs and providers [5, 9, 11, 15]. • Issues include intra-agency disagreements regarding target populations and limited referral mechanisms and expertise across different disciplines [9, 15]. • The complexity of integrating care is compounded by the large, complex urban environment with geographically widespread directly operated and contracted entities [9, 15]. This insufficient integration results in incomplete or inappropriate treatment for consumers [1, 2, 6, 10]. For individuals with serious mental illnesses, the failure to coordinate primary and behavioral health care has led to grave consequences, including chronic medical conditions and early mortality [6, 10]. The sources note that a significant number of people in primary care settings need behavioral health services, but many with diagnosable mental disorders either do not seek mental health care or receive it only from their general physician [6, 10]. Addressing system fragmentation is identified as the highest priority by stakeholders for improving service quality and outcomes [16-18]. The Los Angeles County Department of Mental Health (LAC-DMH) MHSA Innovations Plan is specifically focused on learning how to address this fragmentation and improve the quality of mental health services for specific populations: the uninsured, homeless, and under-represented ethnic populations (UREP) [7, 18-22]. The plan’s primary purpose is learning, focusing on identifying new practices to increase the array of creative and effective approaches, explicitly by addressing system fragmentation [7, 16, 18-20, 22]. The Innovations Plan proposes four innovative models designed to integrate services and counteract this fragmentation: 1. Integrated Clinic Model: Combines mental health, physical health, and substance abuse services in community-based sites to increase access and quality by providing a “home” for integrated care and using a “no wrong door” approach [4, 7, 23-27]. 2. Integrated Mobile Health Team Model: Utilizes a mobile team to deliver integrated services directly to homeless individuals, addressing the fragmentation specific to this population where they are located [4, 7, 26-28]. 3. Community-Designed Integrated Service Management (ISM) Model: Addresses fragmentation for UREP communities by building on community strengths and integrating formal and non-traditional providers based on how the community defines care [4, 7, 26, 27, 29-31]. 4. Integrated Peer-Run Model: Uses a peer-driven approach to help uninsured individuals navigate and coordinate integrated physical health, mental health, and substance abuse care, aiming to reduce fragmentation through the guidance of those with lived experience [7, 26, 27, 31-34]. The plan intends to learn how to overcome the barriers and reduce fragmentation through the evaluation of these models [35-37]. Our conversation history highlights how Ocean Duran’s perspective, informed by lived experience, can provide valuable insight into understanding and addressing system fragmentation [38-40]. Navigating years of homelessness while seeking help from various services provides a deep, ground-level understanding of where the system is disconnected [38-40]. Fragmentation can be seen as a lack of “directional movement” towards recovery and stability, where services remain “still” in silos instead of flowing together with the client’s journey [40-43]. Duran’s focus on understanding processes and workflows [39-41] relates to analyzing these breakdown points. Furthermore, his emphasis on “interactivity,” community collaboration, and engaging “other sources” [41, 44] directly aligns with the need to bridge the gaps and improve communication and coordination that fragmentation inhibits [41]. Ultimately, fragmentation impedes the achievement of “qualitative results” and a “beneficially life experience” for individuals, underscoring why integrated, coordinated care is essential for meaningful outcomes like housing stability and overall well-being [41]. ——————————————————————————– LA County Mental Health Service Fragmentation and Innovation Based on the provided sources and our conversation history, mental health services in Los Angeles County are extensive but face significant challenges, particularly concerning fragmentation and access for underserved populations. The Los Angeles County Department of Mental Health (LAC-DMH) operates the largest mental health service system in the nation, serving approximately a quarter of a million residents annually [1]. The department provides a diverse range of services, including assessments, crisis intervention, case management, and medication support in residential and outpatient settings [1]. The overarching goal of LAC-DMH is to ensure services are available for individuals most challenged by severe and persistent mental illness and to promote recovery, with key concepts including achieving positive outcomes, cultural appropriateness, and addressing disparities in access for ethnic, cultural, and underserved communities [2]. A primary issue identified in the sources is the fragmentation of mental health services [2, 3]. This fragmentation involves the separation of mental health, physical health, and substance abuse care across different settings, agencies, systems, supervisors, and regulations [2]. This lack of integration leads to incomplete or inappropriate treatment for consumers [2, 3] and has resulted in grave consequences, including chronic medical conditions and early mortality, for individuals with serious mental illnesses due to poor coordination of primary and behavioral health care [2]. To address this critical issue, the LAC-DMH developed the MHSA Innovations (INN) Plan [4]. The primary purpose of this plan is learning, specifically identifying new practices to increase the array of creative and effective approaches for mental health services [4, 5]. The highest priority identified through stakeholder process was to Increase the Quality of Services, including Better Outcomes, by addressing this system fragmentation [4, 6, 7]. The Innovations Plan targets specific populations greatly impacted by decreased funding and fragmentation: the uninsured, the homeless, and Underrepresented Ethnic Populations (UREP) [8, 9]. UREP communities include African/African-American, American Indian/Native American, Asian and Pacific Islander, Eastern European/Middle Eastern, and Latino communities [8, 10]. The plan proposes four innovative models designed to integrate services and address the needs of these populations [11, 12]: • Integrated Clinic Model: This model combines mental health, physical health, and substance abuse services in community-based sites like primary care or mental health clinics [11-13]. It aims to increase access by bringing services to familiar locations, reduce stigma by integrating care into primary care settings, and improve quality through multidisciplinary team coordination [11, 12, 14]. A “no wrong door” approach is used, allowing clients to access services from any entry point [11, 14]. Peers are included as staff [11]. • Integrated Mobile Health Team Model: Designed primarily for homeless individuals with mental illness, including those in Permanent Supportive Housing (PSH) [11, 12]. A mobile, multidisciplinary team provides integrated physical health, mental health, and substance abuse services where clients are located (streets, shelters, PSH) [11, 12]. It employs a client-centered, housing-first approach with harm reduction strategies [11, 12] and uses innovative funding mechanisms like project-based service vouchers to ensure ongoing access to services [11]. • Community-Designed Integrated Service Management (ISM) Model: This model explicitly focuses on UREP communities [11, 12]. It seeks to address fragmentation by building on community strengths and allowing communities to define how care is delivered and integrated within trusted institutions [11, 12, 15]. It promotes collaboration between formal and non-traditional community-based providers [11, 12, 15] and uses culturally competent “service integrators,” including trained peers, grounded in ethnic communities [11, 12]. • Integrated Peer-Run Model: Supports uninsured adults with mental health needs, including those in crisis [11, 12]. Programs are designed and run by people with lived experience of mental health issues (peers) [11, 12]. It includes Peer-Run Integrated Services Management (PRISM) and Alternative Peer-Run Crisis Houses as client-driven alternatives to traditional services or hospitalization [11, 12]. The model aims to reduce fragmentation through a peer-driven approach and expand peer-run options within the public mental health system [11]. These models strongly emphasize community involvement [11], cultural competence [11], and the crucial role of lived experience [11, 16-21]. For example, the Community-Designed ISM Model is based on the collective wisdom of UREP subcommittees [8, 11], and the Integrated Peer-Run Model is run by individuals with lived experience [11, 12]. Beyond fragmentation, the sources highlight other specific challenges in integrating mental health services in LA County: • Significant barriers to accessing services for target populations, including stigma [22, 23] and mistrust of formal treatment settings, particularly for UREP members [22, 23]. • Difficulties providing culturally and linguistically competent services countywide [22, 23]. • Challenges incorporating non-traditional practitioners and establishing billing mechanisms for them [23]. • Resistance on the part of some people to referring consumers to consumer-run (peer-run) programs [23]. • A lack of alternatives to institutional and costly options like hospitals for people in crisis [23]. • Funding gaps, such as the absence of dedicated funding for supportive services in permanent supportive housing [23]. The Innovations Plan aims to learn how to overcome these barriers through the evaluation of the proposed models, assessing aspects like the extent of integration achieved, service levels, outcomes, stakeholder satisfaction, and cost-effectiveness [24]. Our conversation history has also explored how concepts from Ocean Duran’s work, such as the value of lived experience in understanding system fragmentation [25, 26], the importance of “directional movement” towards recovery and stability [25, 26], interactivity as community collaboration and system flow [25], and defining outcomes through “qualitative results” and “beneficially life experience” [25, 27, 28], can offer relevant perspectives on addressing these challenges and improving mental health services in LA County [29-31]. ——————————————————————————– LA Mental Health Service Innovation These sources discuss innovative approaches to **mental health service delivery** in Los Angeles County, particularly for **underserved populations**, emphasizing **integration of care**, **community involvement**, and the crucial role of **lived experience**. They outline **specific models** like integrated clinics, mobile health teams, community-designed services, and peer-run programs, aiming to overcome **system fragmentation** and improve **client outcomes**. The sources also incorporate a related philosophical perspective on **innovation, communication, and achieving “directional movement”** through structured processes and leveraging individual and community strengths. ——————————————————————————– Mental Health Innovation and Human Capital Study Guide Study Guide: Mental Health Innovation and Human Capital Development Quiz 1. What is the primary purpose of the MHSA Innovations (INN) Plan in Los Angeles County, as stated in the document? 2. What are the three critical issues the LAC-DMH MHSA Stakeholder Delegates prioritized for attention through innovative strategies? 3. Name three of the five Under-Represented Ethnic Populations (UREP) subcommittees identified in the LAC-DMH plan. 4. Describe the core concept of the Integrated Service Management (ISM) Team within the Community-Designed ISM Model. 5. What are Peer-Run Crisis Houses designed to provide as an alternative to hospitalization? 6. How does the Community-Designed ISM Model propose to address disparities in access to mental health services for UREP communities? 7. According to the “oceanREmixEDscreenplay3-2.pdf,” what is considered the “greatest philosophical resource that we have in our societies”? 8. In the context of the “outline NovationMotivationByOceanDuran.pdf,” what is the significance of finding contrasting elements within an individual and utilizing their environment? 9. What does the “outline NovationMotivationByOceanDuran.pdf” suggest is gained through the studies and production process described? 10. Based on the “outline NovationMotivationByOceanDuran.pdf,” what does “Human capital gain and increase” represent within the framework of personal directives? Answer Key 1. The primary purpose of the MHSA Innovations (INN) Plan is learning, focusing on identifying new practices to increase the array of creative and effective approaches for mental health services. 2. The three critical issues are the fraying safety net for the uninsured, fragmentation of services (mental health, health, substance abuse), and decreased capacity to serve uninsured clients due to shrinking County General Funds. 3. African/African-American, American Indian, Asian/Pacific Islander, Eastern European/Middle Eastern, and Latino. (Any three of these are acceptable). 4. The ISM Team is a multidisciplinary health team that works under one agency or supervision to provide integrated health, mental health, and substance abuse services with client-centered goals. 5. Peer-Run Crisis Houses are designed to provide a warm, safe, welcoming environment for uninsured people in psychiatric distress who are not a danger to others, serving as alternatives to hospitalization. 6. The Community-Designed ISM Model seeks to bridge the gap between ethnic communities and formal care providers by allowing communities to direct how services are integrated into trusted institutions and utilizing community-specific peer-based outreach. 7. The “greatest philosophical resource” is our ability for stimulating our environment, which leads to foundations of relativity and the formation of correlating activities. 8. Finding contrasting elements and utilizing the environment is part of the relation process, which develops a design of discovery that allows an individual to see beyond social obstacles and understand a more accommodating reality. 9. Through these studies and production, more than just a practiced skill is gained; it provides a system for expressing the wisdom that develops during the production process, where objectives become clear through correlative usage. 10. “Human capital gain and increase” represents the strengthening and expansion of an individual’s abilities, knowledge, and skills as a result of the processes and learning described, contributing to their overall worth and capacity. Essay Format Questions 1. Analyze the different innovative models proposed in the LAC-DMH MHSA Innovation Plan. Discuss how each model attempts to address the identified critical issues and serve the target populations, highlighting their unique features and potential benefits. 2. Evaluate the role of stakeholder input, particularly from Under-Represented Ethnic Populations (UREP) communities, in the development and implementation of the Community-Designed Integrated Service Management (ISM) Model. How does this input shape the model’s principles and intended outcomes? 3. Compare and contrast the Integrated Peer-Run Model and the Community-Designed Integrated Service Management Model. Discuss their similarities in goals and differences in approach, particularly concerning the roles of peers and community involvement. 4. Explore the concept of “systematic resourcing” as presented in the “outline NovationMotivationByOceanDuran.pdf.” How does this concept relate to problem-solving and innovation within the context of the provided texts, and what are its implications for achieving desired outcomes? 5. Discuss the intersection of artistic mission, personal development, and community engagement as presented across the provided sources. How do the ideas of self-reliance, environmental stimulation, and the utilization of individual talents contribute to both personal and societal progress? Glossary of Key Terms • Community-Designed ISM Model: An innovative model in the LAC-DMH plan that builds on community strengths, especially in underserved ethnic communities, to integrate health, mental health, substance abuse, and other needed care through collaboration between regulated entities, contract providers, and community-based organizations. • Correlative Practices/Correlative Design: Methods or structures that allow for the measurement of personal success or demonstrate a system of wisdom development by relating different elements or aspects. • Harm Reduction: Strategies designed to reduce the risk of harm associated with certain behaviors, such as drug abuse. • Holistic Support: A comprehensive approach to assisting clients that addresses not only their health, mental health, and substance abuse needs but also other services like transportation, follow-up, encouragement, and communication, often in a culturally and linguistically competent manner. • Human Capital: The skills, knowledge, and experience possessed by an individual or population, viewed in terms of their value or cost to an organization or country. In the context of the source material, it relates to gaining and increasing these attributes. • Integrated Mobile Health Team: A multidisciplinary health team (including mental health, physical health, and substance abuse professionals, as well as specialized staff like housing/employment specialists and peer/family advocates) that provides services to homeless individuals and those in Permanent Supportive Housing (PSH). • Integrated Peer-Run Model: An innovative model utilizing peer support to identify, obtain, and coordinate mental health, physical health, and substance abuse care for uninsured individuals, reducing system fragmentation. It includes strategies like Peer Run Integrated Services Management (PRISM) and Peer-Run Crisis Houses. • Innovation (INN) Plan (MHSA): The final plan component of the Mental Health Services Act in LA County, focused on learning and identifying new practices to increase creative and effective approaches for mental health services. • Mental Health Services Act (MHSA): California legislation that provides funding for expanded county mental health services. The Innovations (INN) Plan is a component of MHSA. • Peer Advocates/Peer Specialists: Individuals with lived experience of mental health issues who provide support, information, motivation, and encouragement to their peers, often assisting with service access and communication. • Peer-Run Crisis Houses: Client-driven, holistic alternatives to hospitalization designed to provide a safe and welcoming environment for uninsured individuals experiencing psychiatric distress who are not a danger to others. • Peer Run Integrated Services Management (PRISM): A client-driven, holistic alternative within the Integrated Peer-Run Model that allows uninsured peers to secure needed physical health, mental health, and substance abuse options as part of a program designed and run by people with lived experience. • Permanent Supportive Housing (PSH): Housing units dedicated to serving the MHSA focal population, often with project-based service vouchers that provide access to integrated support services. • Provisionary Management: A concept described as involving Lingo, Location, and Lending, suggesting a preparatory or qualifying approach to management. • Project-Based Service Vouchers (PBSV): Vouchers committed to housing developers interested in building PSH units, used to leverage housing capital and indicate developer access to integrated services provided by an Integrated Mobile Health Team. • Recidivism: The tendency of a convicted criminal to reoffend. In the context of mental health services, it might refer to individuals dropping out of services or experiencing recurring crises. • Rhythm Patterns N’Mocean (RPM): A concept related to situational events recalling chronological events that direct movement (“M’ocean”) for evidential outcomes, often recognized through patterns that conform to personal methods and principals. • Social Realism: The use of realistic portrayals of life in art or literature to make a social or political point. • Speech Acts Theory: A linguistic theory that analyzes how utterances are used to perform actions, often combined with probability theory to assess behavior. • Stakeholder Delegates (MHSA): A countywide, diverse, and representative group specifically created to ensure wide and meaningful public participation in ongoing MHSA planning in Los Angeles County. • Systematic Implements: Defined as systematic observations of formational elements for progression in the learning curve, applying elemental structure according to artistic plans, and formulating business definitions. • Systematic Resourcing: A basis for understanding what surrounds a centralized focus for remedial needs or innovation, involving performance production and a resourcing process to help remedy a cause. • Under-Represented Ethnic Populations (UREP): Communities that have been historically on the periphery of the mental health system, identified in Los Angeles County as African Immigrant/African American, American Indian, Asian Pacific Islander, Eastern European/Middle Eastern, and Latino. • Universal Design: A structured formation or processing method that, by process of elimination, aims to prove the absolution of designs. • Vulnerability Index (Common Ground): A method used to assess the vulnerability of homeless individuals, often determining those most likely to die within the next year based on disabling conditions. ——————————————————————————– Mental Health Innovation Timeline and Participants Here is a detailed timeline of the main events covered in the sources, followed by a cast of characters: Timeline • September 11, 2007: Ographer Ocean Duran publishes “Genesis with Videos” on his blog, reflecting on his origins as a choreographer and his early understanding of “design” stemming from teaching. • 2008: Ocean Duran writes “N D’fining WORD,” his first spoken word poem, which explores the importance of words, truth, and etymology and later becomes a copyrighted song and remix. • January 30, 2009: The State Department of Mental Health releases Information Notice No. 09-02, outlining guidelines for the Mental Health Services Act (MHSA) Innovation Plan (INN). • February 18, 2009: The Los Angeles County MHSA Stakeholder Delegates endorse a planning process for the Innovations Plan focusing on three critical issues: the fraying safety net for the uninsured, fragmentation of services, and decreased capacity to serve uninsured clients. They also prioritize three target populations: the uninsured, the homeless, and Underrepresented Ethnic Populations (UREP). • May 2009: The extensive and intensive planning process for the LAC-DMH Innovations Work Plan begins, picking up pace after the May 19th election. • June 24, 2009: The Los Angeles County MHSA Stakeholder Delegates approve a planning structure for the Innovations Plan, including broad public input, workgroups focused on target populations, and the inclusion of consumers, family members, parents, and caregivers in formal decision-making roles. • October 19, 2009: Ographer Ocean Duran publishes “Syncronicites” on his blog, reflecting on healing and finding the fundamentals of basic structures to truly living. • October 21, 2009: Ographer Ocean Duran publishes several blog posts, including reflections on his birthdate, astrology and astronomy, being “Synced UP” (finding repetition in personal truths), and quizzes about which Egyptian god/goddess, Greek god/goddess, planet, and Bible story he would be. • October 22, 2009: Ographer Ocean Duran continues to publish quiz results on his blog, including Sekhmet (Egyptian goddess), Athena (Greek goddess), Jupiter (planet), and the Story of Abraham (Bible story). • October 25, 2009: Ographer Ocean Duran publishes “RainbowRemix,” documenting his first attempt to remix using the concept of a rainbow. • October 20 – November 19, 2009: A 30-day public comment period is completed for the LAC-DMH MHSA Innovation Plan. • November 18, 2009: The 30-day public comment period for the LAC-DMH MHSA Innovation Plan concludes. • November 19, 2009: A Public Hearing for the LAC-DMH MHSA Innovation Plan is hosted by the Los Angeles County Mental Health Commission, chaired by Jerry Lubin and facilitated by Rigo Rodriguez. • November 24, 2009: Ansara J. Lewis prepares the Innovation Projected Revenues and Expenditures for several Work Plans for the LAC-DMH MHSA Innovation Plan. • December 1, 2009: The County of Los Angeles Department of Mental Health (LAC-DMH) submits a request to amend its MHSA Agreement to include increased funding for FY 2009-2010, including the MHSA Innovation Plan (INN) for review and approval. The total amount requested for the INN Plan is $20,293,924 for FY 2009/2010. • January 2010: Estimated Plan Approval from the California Department of Mental Health for the MHSA Innovation Plan. Implementation timelines for the Integrated Clinics Model, Community-Designed Integrated Service Management (ISM) Model, and Integrated Peer-Run Model are set to begin operations in January 2010. • February – April 2010: Competitive Bidding Process for the Innovation Plan projects. • March 17, 2010: Ographer Ocean Duran publishes “Artists OceanREmixED,” a montage mix of artists he choreographed for. • April 12, 2010: Ographer Ocean Duran publishes “oceanremix rainbowED sounding N2N 2evening,” a piece with Genesis themes. • April 22, 2010: Ographer Ocean Duran publishes an Untitled Post with themes related to Genesis and structured observations. • May – July 2010: Contract Negotiations, Board Approval, and Awarding of Contracts for the Innovation Plan projects. • August – October 2010: Start up and Staffing of Integrated Service Management (ISM) Teams and Peer-Run Models begin, including training of culturally diverse staff. • November 1, 2010: The first Quarterly Formative Evaluation and Reporting for the ISM Model takes place. Barriers to implementation are identified and addressed. • November 2010 – January 2011: Outreach, Engagement, Linkage, Education and Training activities for the ISM Model are evaluated. • February – May 2011: ISM Services are provided to Families. • June 1, 2011: The third Quarterly Formative Evaluation and Reporting for the ISM Model takes place, measuring service completion, assessing the effectiveness of non-traditional providers, and evaluating the reduction of implementation barriers. • June 2011 – August 2012: ISM Services continue to be provided to Families, with information gathered on the number of non-traditional community-based partners providing services. • September – December 2012: Summative Evaluation/Final Report for the ISM Model is completed, and results and learnings are shared with various audiences. This also marks the estimated end of the initial two years of INN funding for the ISM and Peer-Run Models. • 2012: Ographer Ocean Duran copyrights “MasterPiece N’Mocean.” • April 15, 2025: The UK hosts a global conference to address Sudan’s civil war, coinciding with the second anniversary of the conflict. (Mentioned in Ocean Duran’s blog, indicating his awareness of current events). Cast of Characters • Marvin J. Southard, D.S.W.: Director of the County of Los Angeles Department of Mental Health (LAC-DMH). • Roderick Shaner, M.D.: Medical Director of the County of Los Angeles Department of Mental Health (LAC-DMH). • Robin Kay, Ph.D.: Chief Deputy Director of the County of Los Angeles Department of Mental Health (LAC-DMH). • Gladys Lee, LCSW: District Chief of the LAC-DMH Planning Division and the primary point of contact for the MHSA Innovation Plan submission. • Jerry Lubin: Chair of the Los Angeles County Mental Health Commission who chaired the Public Hearing on the Innovations Plan. • Rigo Rodriguez: Facilitator of the Public Hearing on the LAC-DMH Innovations Plan. • Ansara J. Lewis: Prepared the financial projections (Innovation Projected Revenues and Expenditures) for several Work Plans within the LAC-DMH MHSA Innovation Plan. • Ocean Duran / Ographer Ocean Duran / duran penamante: An artist, choreographer, and author of “MasterPiece N’Mocean” and “NovationMotivationByOceanDuran.pdf”. He explores themes of artistic mission, social realism, innovation, motivation, personal development, and systematic approaches through his writing and other creative work, including videos and music remixes. • Los Angeles County MHSA Stakeholder Delegates: A diverse and representative group created to ensure public participation in MHSA planning. They played a key role in defining the focus and structure of the Innovations Plan. • Peggy Edwards: Submitted two strategies for consideration in the MHSA Innovations Plan, focusing on an ACE Study-Based System and a Vulnerable Veterans Initiative. • AFSCME: Submitted two strategies for the MHSA Innovations Plan related to advocacy for employment ease for persons with disabilities and seeking substance abuse treatment for individuals with Section 8 housing. • James Randall: Associated with DMH and submitted strategies including “Consumer and Family” and “Recovery After Initial Schizophrenia Episode (RAISE) Program”. • Underrepresented Ethnic Populations (UREP) Subcommittees: Five distinct subcommittees representing the African Immigrant/African American (A/AA), American Indian (AI), Asian Pacific Islander (API), Eastern European/Middle Eastern (EE/ME), and Latino communities. Their collective wisdom informed the development of culturally competent approaches, particularly the Community-Designed Integrated Service Management Model. • Consumers, Families, Parents, and Caregivers: Key stakeholders who provided input and held formal decision-making roles in the planning of the MHSA Innovations Plan. They are also the intended beneficiaries of the services. • Community Mental Health Contract Providers: Organizations expected to contract with LAC-DMH to implement the various Innovations Plan projects. • Non-traditional Community-Based Providers: Partners within the Community-Designed ISM Model who integrate services within trusted community institutions, often drawing on cultural strengths and resources. • Housing Developers: Entities interested in building Permanent Supportive Housing (PSH) and who can leverage project-based service vouchers provided by LAC-DMH to increase the availability of PSH units. • Various Organizations and Individuals who Submitted Strategies: (As listed in the MHSA-Innovations (INN) Strategies Submission Log, including but not limited to: Stars, Inc., Black Los Angeles County Client Coalition (BLACCC), Inner City Industry (ICI), Heritage Clinic, DPSS, CONNECTING – it works! Inc, Tarzana Treatment Centers, Don Parrington, SF Valley Community Mental Health Center, Didi Hirsch Mental Health Services, Mandy Johnson, Mollie Lowery, Community Clinic Association of LA, LA Gay & Lesbian Center, Long Beach TAY Collaborative, Step up on Second, Community Family Guidance Center, Mary Lind Recovery Centers, DMH-Older Adult Programs Admin, Latino UREP, Para Los Ninos, Child Care Resource Center (CCRC), Project Return, Kedren Community Health Center, Skid Row Housing Trust, California Healthy Marriages Coalition, Prototypes, Armenian Relief Society of West USA, Diane McNeal, EE/ME UREP, Children’s Institute, LA Child Guidance Clinic, Vista Del Mar Child and Family Services, Special Service for Groups, Laurel Bear, Rosalie Finer-Alliant Int., Family Service, LBHI, Antelope Valley Partners for Health, AI UREP, SCHARP, Therese Haviland, Children’s Hospital, Choices Recovery Services, Kathy Millet, DMH – EAD, Ruth Hollman). These individuals and organizations represent a broad range of service providers, advocacy groups, and community initiatives that contributed ideas for innovation in mental health services in Los Angeles County. ——————————————————————————– LA Mental Health Innovation for Underserved Communities These sources discuss innovative approaches to mental health service delivery in Los Angeles County, particularly for underserved populations, emphasizing integration of care, community involvement, and the crucial role of lived experience. They outline specific models like integrated clinics, mobile health teams, community-designed services, and peer-run programs, aiming to overcome system fragmentation and improve client outcomes. The sources also incorporate a related philosophical perspective on innovation, communication, and achieving “directional movement” through structured processes and leveraging individual and community strengths. ——————————————————————————– Ocean Duran: Bridging Fragmentation Through Lived Experience and Strategy Based on the sources and our conversation, your query explores how Ocean Duran, even when viewed from a perspective outside traditional professional hierarchies (perhaps the “average point of view”), can effectively contribute to addressing systemic issues, particularly the fragmentation in mental health and housing services, by leveraging his unique blend of lived experience, philosophical insights, and systematic thinking, specifically through presenting opportunities for collaboration. While the sources do not use the term “average point of view,” they strongly support the idea that valuable insights and capacities for change can come from individuals and communities, particularly those with lived experience, rather than solely from formal institutions or traditional professionals [1-9]. Duran’s work aligns with this, emphasizing self-reliance, utilizing individual talents and experiences, and building support systems based on acquired skills and personal values [3, 10-14]. Here’s how Duran, drawing on his knowledge base, ethics, and skills as described in the sources, could approach helping the cause from this perspective: 1. Leveraging the Homeless Knowledge Base for Practical System Insight: ◦ The sources explicitly state that Duran’s awareness of the lived experience of homelessness can be vital for the LAC-DMH plan [1]. This is because navigating years of homelessness while seeking help from various services (like health, mental health, and housing support) provides a deep, ground-level understanding of system fragmentation – exactly where services are disconnected, where communication fails, and what barriers (like separate funding streams or limited referral mechanisms) truly impede progress for individuals [1, 15]. ◦ His successful journey to stable housing, even after 8 years of homelessness, exemplifies “directional movement” towards recovery and stability [1, 16]. This provides a real-world case study of overcoming immense obstacles within the existing system, offering practical insights into what types of support (like health programs, mental health workshops, and housing assistance from organizations like OPCC and Venice Family Clinic, even if not explicitly in the sources) are needed and how they must function together to produce tangible results [1, 7, 17]. ◦ This lived experience informs the value of peer support [1, 4, 5, 18]. Someone who has successfully navigated the system is uniquely positioned to understand the challenges peers face and how to be effective “peer bridgers” [1, 19]. 2. Integrating Philosophical/Moral Ethics (like “Sound Doctrine”) as a Guiding Principle: ◦ While the sources don’t define a specific “sound doctrine” related to ethics in the context of system change, Duran’s work (linked to oceanduran.com/livingwaters.blog) is underpinned by a philosophy (“OceansOntology101”) and an artistic mission that seeks to find “truth,” “understanding,” and make “a social or political point” through realistic portrayals of life [10, 20-25]. ◦ Concepts like understanding “truth is relative” [26], seeking “absolution and Truth” [27], and recognizing that “expressions need to be themselves” [28] reflect a personal ethical or moral framework guiding his perspective. ◦ His “Systematic Resourcing” is described as a “Resourcing process to help remedy a cause” [29], and his work aims for a “beneficially life experience” [16, 28]. This suggests a core value proposition centered on healing and creating positive, life-enhancing outcomes, acting as the moral drive behind his desire to contribute to the cause of addressing system failures [16, 29, 30]. This ethical foundation provides the purpose for applying his skills and knowledge. 3. Applying “Academic Management” Skills (Business/Systematic Thinking) for Structure and Action: ◦ Duran’s work explicitly uses concepts found in business and management, such as “visionary management practices” [14], “Program Planning Model” [14], “Impact Assessment” [30, 31], “Systematic Implements” [29, 32], “Systematic Resourcing” [29, 33], “Performance Production” [29], “Resourcing process to help remedy a cause” [29, 34], “organizing information and implementing a strategy to the work order and streamlining it” [28], “Qualitative expectations” [32], and “Strategic communication tactics” [35]. ◦ He frames his artistic/production ideas using this structured language, describing “Performers Paramount” as a “formulation of strategies” to create a “fully functional system” [36, 37] and “Reaching for the Stars” as a “streamlined work flow order” [16]. ◦ These skills provide him with the methodology to analyze complex problems (like fragmentation) and design structured solutions [14, 28, 32, 33]. He can identify “weaknesses” in a system [34], define processes, and propose “strategic implements” [29]. This systematic thinking allows him to translate his lived experience and philosophical drive into actionable frameworks. 4. Presenting Opportunities for Collaboration to “Reinstate Developments”: ◦ Duran’s models are inherently collaborative, emphasizing “new personal network relations” [38, 39], “community collaboration” [38, 40], utilizing the “community of the arts network” [37, 38], and engaging “other sources, not usually associated to it” [3, 41]. ◦ By presenting his structured models (like “Performers Paramount” or the “Novation Motivation” program planning outline) [32, 36], which are based on his lived experience, philosophical drive, and management skills, he creates a concrete framework for potential partners (whether in the arts, business, or even public service sectors like LAC-DMH or housing providers) to engage with [38, 42, 43]. ◦ These models are designed to create opportunities and facilitate interaction, directly counteracting the fragmentation that he has experienced and that the LAC-DMH seeks to heal [2, 15, 17, 38, 44-49]. ◦ Presenting a structured, collaborative initiative rooted in the understanding of overcoming fragmentation can indeed offer a way to “reinstate developments” – meaning, potentially, to reactivate or create new connections and functional processes that are currently lacking or broken within the fragmented system. His approach, as described in the sources, is an “innovative remedy for the cause” (fragmentation) [16]. In summary: Even from an “average point of view” (meaning, perhaps, one rooted in lived experience and personal initiatives rather than solely formal institutional roles), Duran’s combination of a profound homeless knowledge base (providing practical insight into system failure), a philosophical/ethical drive (providing the purpose and focus on healing and positive outcomes), and applied business/management skills (providing the structure and methodology) equips him to effectively approach helping the cause. He can do this by articulating the real-world impact of fragmentation from a survivor’s perspective, proposing structured, collaborative initiatives that counteract this fragmentation, and leveraging his personal journey as proof of concept for resilience and the possibility of achieving stable housing and a “beneficially life experience” through resourcefulness and support [1, 3, 16, 28]. His ability to frame these insights and initiatives using a systematic, collaborative language makes them accessible and actionable for potential partners seeking to address the same issues [14, 32, 35]. ——————————————————————————– Integrating Concepts for Mental Health System Innovation Based on the sources and our conversation, here is a detailed and qualitative report integrating Ocean Duran’s concepts (knowledge, timing, interactivity, paramount success/outcomes) to address the persistent challenges of mental health service fragmentation in Los Angeles County (LAC), and how Duran might approach answering the city’s call for innovative solutions. Report: Integrating Artistic and Systemic Concepts to Address Mental Health Service Fragmentation in Los Angeles County Introduction Los Angeles County Department of Mental Health (LAC-DMH) operates the largest mental health service system in the nation [1]. Despite this scale, a significant challenge identified in the sources is the pervasive fragmentation of services, particularly the separation of mental health, physical health, and substance abuse care [29-1-13, 33-4, 33-5]. This fragmentation is deemed a major impediment to service quality and good outcomes , leading to incomplete or inappropriate treatment and, for those with serious mental illness, grave consequences like chronic medical conditions and early mortality due to poor coordination . The LAC-DMH MHSA Innovations Plan is specifically designed as a “learning grant” to identify new practices and increase effective approaches for mental health services by addressing this fragmentation [1-13]. Integrating concepts from Ographer Ocean Duran’s work, particularly his “Novation Motivation” and “MasterPiece N’Mocean” frameworks, offers a unique lens through which to analyze the challenges and propose innovative solutions for this fragmentation. Duran’s perspective, rooted in artistic production, systematic resourcing, and the value of lived experience, can provide qualitative insights into building more coherent, effective, and client-centered systems. Integrating Duran’s Concepts into Addressing Fragmentation Challenges We can integrate Duran’s concepts of knowledge, timing, interactivity, and paramount success/outcomes by applying them to the identified challenges of fragmentation: 1. Knowledge as Gained Through Lived Experience and Process: ◦ Duran’s framework emphasizes knowledge gained through “Art imitating Life,” “stimulating our environment,” and developing “foundations to relativity and the formation of correlating activities” [11, 12]. He highlights gaining “extensive knowledge to basic managerial skills” [14] and using “his own experiences to relate” [15, 16] to understand processes and workflows [17, 18]. ◦ Applying this to LAC-DMH: The Innovations Plan explicitly values “lived experience” in service delivery, particularly in the Integrated Peer-Run Model [1, 2, 8, 19-21]. Duran’s perspective underscores that practical knowledge of navigating the fragmented system is a vital resource [19]. Individuals who have experienced the separation of services, the confusion of disparate funding streams, the difficulties in communication, and the lack of coordinated referrals [1, 3] possess crucial knowledge about where the system breaks down [19]. This “design of discovery” that arises from navigating obstacles and understanding a “more accommodating reality” [22] is the kind of knowledge needed to build systems that truly work from the client’s perspective [19]. Duran’s focus on “streamlining practices” [17] and creating a “proper workflow” [17, 18, 23] offers a conceptual approach to simplifying the complex and disjointed service landscape identified in the sources [1, 3]. 2. Timing as “Directional Movement” and Responsive Action: ◦ Duran’s concept of “timing” is linked to “directional movement” [24, 25], the flow of “M’ocean” [26], and recognizing “rhythm patterns” based on overcoming past situations [26]. Success is seen in this “movement”; if an object is “still,” action is needed to involve the customer [27, 28]. ◦ Applying this to LAC-DMH: Fragmentation leads to services being “still” or stuck in silos, impeding clients’ “directional movement” towards recovery and stability [1, 3, 19, 24]. The lack of coordinated care means clients might drop out or experience recurring crises without timely, appropriate support . This represents a failure in “timing” – the system doesn’t move with the client. The Integrated Mobile Health Team Model, which goes to homeless clients where they are [1, 2, 8, 21, 29], exemplifies a system designed to initiate “directional movement” [19, 24, 25]. The lack of alternatives to costly institutional options for mental health crises [3, 5, 9] is a direct timing issue; services aren’t available at the right moment or in the right setting. Peer-Run Crisis Houses [1, 2, 8, 21, 30, 31] offer a responsive, timely alternative [19]. Duran’s concept of understanding rhythm by surpassing situations [26] suggests that evaluating successful client journeys can inform system design to better anticipate and respond to critical moments in a client’s path. 3. Interactivity as Community Collaboration and System Flow: ◦ Duran emphasizes “stimulating our environment” [11, 12], developing “new personal network relations” [32, 33], “community collaboration” [34, 35], and engaging “other sources, not usually associated to it” [36]. He sees “contributions from each performer and crew member” as vital to the production [37, 38] and the value of expression perceived through the “communicative value of process” [39]. “Getting others to move all~together” creates impact [40, 41]. ◦ Applying this to LAC-DMH: Fragmentation is fundamentally a lack of interactivity between different parts of the system – providers, agencies, funding streams, data systems [1, 3]. Duran’s vision of collaborative “production” [34, 35, 38] aligns directly with the need for improved communication, coordination, and information sharing [1, 3]. His concept of engaging “other sources” and leveraging community strengths [36] is the core principle of the Community-Designed Integrated Service Management (ISM) Model [1, 2, 8, 19-21, 42], which seeks to integrate formal and non-traditional providers and community networks [1, 2, 8, 19, 21, 42]. This approach directly addresses barriers faced by UREP communities, such as mistrust and lack of culturally appropriate services, by embedding care within trusted community contexts [1, 5, 8, 9, 43, 44]. The multidisciplinary team approach in the Integrated Clinic and Mobile Team models is also built on the necessity of interactivity and collaboration among different professional disciplines [1, 2, 8, 19, 21, 29]. 4. Paramount Success/Outcomes as “Qualitative Resolve” and “Beneficially Life Experience”: ◦ Duran’s models aim for “qualitative results” [2, 34, 45, 46], “qualitative resolve” [24, 25], assessing “impact” [40], and providing a “beneficially life experience” [25, 37]. Success is achieved through streamlining processes, creating opportunities, fostering growth [24, 37, 38], and satisfying needs [24, 47]. ◦ Applying this to LAC-DMH: The Innovations Plan’s highest priority is to “Increase the Quality of Services, including Better Outcomes” [2, 19, 21, 29, 42, 48, 49], explicitly linking quality to addressing fragmentation [2, 19, 21, 29, 42, 48, 49]. Duran’s emphasis on “qualitative results” [2, 34, 45, 46] and “beneficially life experience” [25, 37] offers a framework for defining successful outcomes beyond clinical metrics or service utilization. For example, achieving and maintaining housing stability, as a goal for the homeless population addressed by the Mobile Team Model [1, 2, 8, 19, 21, 29, 50], is a clear “beneficially life experience” and a “qualitative result” stemming from integrated support [19, 24, 25]. Poorly defined outcome measures are a challenge for the county [3]. Duran’s focus on “qualitative resolve” from “structured components” [24, 25] and grading “performance” on “satisfactory results” [46] suggests a method for defining success based on the tangible positive changes in clients’ lives resulting from the integrated system’s performance. Assessing impact [40] from the client’s perspective, based on their improved “quality of living” [51, 52] or ability to adapt [28], could be a valuable addition to traditional outcome measures. How Duran Would Approach Answering the City’s Call If Ocean Duran were to respond to LAC-DMH’s call for innovative solutions to service fragmentation, his approach, informed by the provided sources, would likely be presented as a “Qualitative Production Model” [2, 34, 35] designed to create “directional movement” [24, 25] and achieve “qualitative resolve” [24, 25] for vulnerable populations navigating the system. His answer would likely frame the fragmented mental health system as a process needing a “streamlined workflow order” [18, 24, 25] and propose a “Systematic Resourcing” approach [53-55]. He would likely: 1. Diagnose the Fragmentation as a Lack of “Directional Movement” and System “Stillness”: He would identify the current state as lacking flow and coordination [1, 3], inhibiting client progress [19, 24, 25]. This “recession state due to a malnutrition system” [55] needs a “remedial component” [24, 25]. 2. Propose a “Performers Paramount” Model: He would envision the integrated service system as a collaborative “production” [2, 34, 35], where various components – mental health providers, physical health clinics, substance abuse programs, housing specialists, and crucially, clients and peers – are all “performers” [34, 35]. Each “performer” contributes their unique “talents and experiences” [16, 56] to the overall show (the client’s journey) [37, 38]. 3. Emphasize “Community Collaboration” and “Outsourcing External Influences”: Aligning with the Community-Designed ISM concept [2, 21, 42], he would stress the importance of leveraging community networks and non-traditional resources [24, 32, 33, 36, 47, 57, 58] to create a “fully functional system” that reaches beyond traditional boundaries [18, 24]. 4. Champion the Role of “Lived Experience” as Key “Service Integrators”: He would highlight that individuals with lived experience (peers) possess essential knowledge [19] gained from navigating the fragmented system. They are uniquely positioned as “service integrators” [42, 59] or “peer bridgers” [19] who understand the “process” [15, 39] and can provide crucial “directional movement” [19, 24, 25] for others. This aligns with the Integrated Peer-Run Model [1, 2, 8, 21, 30, 31]. 5. Focus on “Qualitative Results” and “Beneficially Life Experience” as Core Outcomes: He would propose measuring success not just by clinical metrics or service volume, but by the tangible, positive changes in clients’ lives, such as achieving housing, improving well-being, and feeling supported by a coherent system [19, 25, 37]. This involves assessing impact [40] and seeking “qualitative resolve” [24, 25]. 6. Develop a “Systematic Approach”: His proposal would be a structured plan [18, 23, 24, 60] for implementing this collaborative production model, outlining the “formational elements” [60], “work flow designs” [35], and “critical resource functionality” [53, 54] needed to create a streamlined, interactive system that remedies fragmentation [25, 53-55]. He might use concepts like “Rhythm Patterns N’Mocean” [26] to analyze client journeys and identify where interventions are needed to create “movement” [27, 28]. In essence, Duran’s answer would be a call to view the mental health system not as a collection of disparate parts, but as a collaborative “production” where every element, especially those with lived experience and deep community roots, performs a vital role in creating a streamlined process that delivers measurable, qualitative, and ultimately “beneficially life experiences” for those navigating the path to recovery. It would be a proposal for an “innovative remedy for the cause” [25] of fragmentation rooted in the power of collaboration and the wisdom of experience. ——————————————————————————– Integrating Los Angeles Mental Health Services share settings SourcesChatStudio arrow_back All notes 5/3/2025 button_magic Source guidearrow_drop_down Lived Experience Informs Mental Health Innovations Based on the sources and our conversation, your query highlights a key aspect of how Ocean Duran’s perspective, informed by lived experience, could be vital for the Los Angeles County Department of Mental Health (LAC-DMH) Innovations Plan. While the provided sources do not contain information about Ocean Duran’s specific experience of homelessness for 8 years in Santa Monica or receiving help from Venice Family Clinic and OPCC, they do discuss the value of “lived experience” and explicitly include the homeless population as a target group for the Innovations Plan models [1-27]. Ocean Duran’s awareness of the lived experience of homelessness, as discussed in the sources, can be vital for several reasons in the context of the LAC-DMH plan: 1. Informing the Value of Lived Experience in Service Delivery: The LAC-DMH plan, particularly the Integrated Peer-Run Model, is explicitly designed to be run by “people with lived experience of mental health issues” [13, 19, 28, 29]. The plan recognizes the critical role peers play in supporting recovery and navigating services [19, 28-39]. Duran’s own work emphasizes utilizing individual talents and experiences [40] and using “his own experiences to relate” [41]. This aligns perfectly with the plan’s intent to leverage the unique insights and empathy that come from having navigated similar challenges. 2. Understanding System Fragmentation: The LAC-DMH plan identifies system fragmentation as a major impediment to service quality and good outcomes, making it the highest priority to address [6, 9, 12, 13, 42]. Duran’s work, as interpreted in the podcast, puts a massive emphasis on understanding processes and workflows [43] and seeking to create “qualitative resolve” through structured components [44]. A person who has experienced this fragmentation firsthand, as Duran did during 8 years of homelessness seeking help, has a deep, practical understanding of the barriers [8] (like separate funding streams, intra-agency disagreements, limited referral mechanisms [45]) that the Integrated Clinic [7], Integrated Mobile Health Team [10], and other models aim to overcome [2-4, 6, 9, 12, 13]. This awareness can inform the design of solutions that truly work on the ground. 3. Enhancing Peer Support and “Peer Bridger” Roles: The podcast specifically connects Duran’s focus on utilizing individual talents/experiences to the peer-run model and community-designed approach [40]. It further links Duran’s focus on peer-to-peer dynamics and valuing lived experience to the concept of “peer bridgers” in the county plan, suggesting his perspective could offer practical insights for strengthening these roles [46, 47]. Peer bridgers help clients navigate the system [46], and someone with direct, successful experience doing so is uniquely positioned to understand what makes these roles effective. 4. Focusing on “Directional Movement” Towards Recovery and Housing: Duran’s “Reaching for the Stars” concept is described as a “remedial component to what lacks in the present recession, directional movement” [44]. Achieving housing after 8 years of homelessness is a clear example of significant “directional movement” towards stability and recovery. The Integrated Mobile Health Team Model specifically uses a “housing-first approach” [3, 10, 17, 23, 27, 48, 49] with the primary goal of addressing fragmentation for the homeless population and providing the supports necessary to secure and retain housing [10, 23, 48, 50-53]. Duran’s lived experience of successfully navigating this journey underscores the importance of such targeted “directional movement” and can inform strategies for supporting others in achieving similar outcomes. 5. Contributing to Outcome Measurement and Quality Improvement: The LAC-DMH plan prioritizes increasing the quality of services and achieving better outcomes [6, 9, 12, 13, 22, 42]. Duran’s work, in the context of “Novation Motivation,” discusses assessing impact [47] and aiming for “qualitative resolve” [44]. His successful experience highlights a vital outcome (housing stability) and the complex journey to get there, which can provide valuable perspective for defining and measuring success beyond simple service utilization counts [47, 54]. The plan intends to use data to drive outcomes and improve systems [55], and the insights from successful lived experiences are crucial for identifying what “better outcomes” truly mean for individuals facing homelessness. In summary, while the specific details of Duran’s path are not in the sources, his awareness of the lived experience of prolonged homelessness and ultimately achieving housing exemplifies the very challenges and desired outcomes the LAC-DMH Innovations Plan, particularly the models targeting the homeless population and utilizing peer support, seeks to address [2-4, 6, 9, 10, 12-19, 22, 42]. This awareness, viewed through the lens of his artistic and systemic frameworks (as discussed in the podcast and outline) which emphasize understanding processes, utilizing individual experiences, and facilitating “directional movement,” provides a vital, ground-level perspective on overcoming fragmentation, building effective support systems, and achieving meaningful recovery and housing stability [40, 41, 43, 44, 46]. ——————————————————————————– Qualitative Production and Artistic Community Collaboration Based on the “NOVATION MOTIVATION” outline, the author, presumably Ocean Duran as indicated by “Ographer Ocean Duran” [1, 2], sees a solution through what can be interpreted as “foreseeable relations” within the artistic and business community. While the exact term “foreseeable relations” is not used, the document emphasizes the importance of new personal network relations [3], the community of the arts network [4], community collaboration [5], and leveraging these relationships for growth and creating opportunities [6-8]. The author proposes a solution through a “Qualitative Production Model” called “Performers Paramount” and an outreach program called “Reaching for the Stars” [2, 9]. These models are designed to provide for performance and production, aiming for qualitative results [9]. The structure implies that each component involved, including relationships and collaborations, is a performer based on its ability to facilitate the production process [9]. The solution proposed by these “foreseeable relations” involves: • Streamlining the process of creating a production into a fully functional system [4]. This relies on outsourcing external influences, such as social class, culture, reference groups, and family and friends, to help create the system [4]. • Creating a networking resource of various creative outlets [8]. This allows for new relations and connections to be produced, leading to growth on both micro and macro levels [8]. • Utilizing the community so that needs are satisfied and met [8]. The success of an event relies on communication, quality talent, artistic appeal, and the ability for growth [6]. • Providing work and job opportunities for talent and industry professionals [2]. The “Reaching for the Stars” outreach program, built on the foundation of “Performers Paramount,” aims to achieve this by embracing a more incorporated idea and creating a streamlined workflow order [2]. This becomes a remedial component to what is lacking in the present recession, specifically directional movement [2]. • Overcoming challenges and addressing weaknesses by recognizing variables and formation [10, 11]. The structured components of “Performers Paramount” offer “qualitative resolve” [2]. • Implementing strategies to achieve outcomes and benefits [12]. Contributions from each performer and crew member contribute to the show so that growth occurs and a resourceful networking process creates opportunities [7]. In essence, the author sees the solution stemming from the ability to effectively organize information and implement strategies [1] by leveraging the inherent strengths and collaborative potential of the artistic community and its network [4, 6-8]. This network, or the “foreseeable relations,” provides the foundation and resources necessary to create a functional system that produces opportunities, fosters growth, and addresses challenges within the industry, offering a “beneficially life experience” [2]. ——————————————————————————– Mental Health Innovation, Art, and Community Process Here is a detailed briefing document reviewing the main themes and most important ideas or facts from the provided sources: Briefing Document: Mental Health Innovation and Artistic Expression as a Framework for Understanding Process and Value This briefing document synthesizes key information from excerpts of the Los Angeles County Department of Mental Health (LACDMH) Mental Health Services Act (MHSA) Innovation Plan (INN) from 2009 and two documents by Ographer Ocean Duran, “oceanREmixEDscreenplay3-2.pdf” and “outline NovationMotivationByOceanDuran.pdf”. While seemingly disparate, these sources offer insights into distinct yet potentially overlapping approaches to innovation, community engagement, addressing unmet needs, and the value of lived experience and creative processes. Source 1: LACDMH MHSA Innovation Plan (INN) Main Theme: Addressing fragmentation and increasing access to mental health, physical health, and substance abuse services, particularly for underserved and under-represented populations, through innovative, community-driven, and peer-supported models. Most Important Ideas/Facts: • Purpose of the MHSA Innovation Plan: The plan is explicitly focused on “learning rather than service provision,” aiming to “identif[y] new practices for the primary goal of learning and increasing the array of creative and effective approaches that can be applied to mental health services for specified populations.” The primary purpose, identified through stakeholder process, is to “Increase the Quality of Services, including Better Outcomes” by addressing “system fragmentation.” • Target Populations: The plan prioritizes three populations greatly impacted by decreased funding and fragmentation: ◦ The uninsured ◦ The homeless ◦ Underrepresented ethnic populations (UREP), specifically African/African American, American Indian/Native American, Asian and Pacific Islander, Eastern European/Middle Eastern, and Latino communities. • Critical Issues Identified: The plan highlights three critical issues requiring innovative strategies: ◦ “the fraying safety net of mental health, health and other social services for the uninsured, as a result of decreased funding and growth in the number of uninsured persons” ◦ “the fragmentation of mental health, health, and substance abuse services” ◦ “the decreased capacity to serve uninsured clients potentially displaced from services as a result of shrinking County General Funds.” • Key Innovation Models Proposed: The plan details several models designed to address these issues and serve the target populations: ◦ Community-Designed Integrated Service Management (ISM) Model: This model addresses fragmentation by “building on the strengths of a community, especially underserved ethnic communities.” It involves collaboration between formal providers and community-based organizations to integrate health, mental health, substance abuse, and other needed care. A core principle is to “provide effective mental health treatment to UREP communities, the public mental health system must adopt culturally competent and holistic strategies anchored in and supported by UREP communities that complement and enhance formal mental health services.” The model includes peer-based engagement, enhanced linkage and advocacy, and the intertwining of formal and non-traditional services. ◦ Integrated Peer-Run Model: This model utilizes peer support to address mental health, physical health, and substance abuse issues. It incorporates two strategies: Peer-Run Integrated Services Management (PRISM), a client-driven, holistic alternative for uninsured peers, and Alternative Peer-Run Crisis Houses, client-driven alternatives to hospitalization run by peers, including one dedicated to individuals released from jail. This model is innovative in combining these strategies and expanding possibilities for peer staffing, including administration and supervision. ◦ Integrated Mobile Health Team Model: This model utilizes multidisciplinary teams (physical health, mental health, substance abuse professionals, and specialized staff like housing/employment/benefit establishment specialists and peer/family/parent advocates) to provide services to homeless individuals, particularly those in permanent supportive housing (PSH). A unique feature is the use of “project-based service vouchers” tied to PSH units to leverage housing capital and ensure continued access to integrated services even if a client moves. Services are client-centered and based on identified needs (housing, physical health, mental health, or substance abuse). • Emphasis on Cultural Competence and Stakeholder Input: A cornerstone of the planning process was the empowerment of UREP groups to inform culturally and linguistically-competent approaches. The plan specifically mentions five distinct UREP subcommittees whose “collective wisdom” guided the development of the Community-Designed ISM Model. Stakeholder input was sought throughout the planning process and is integrated into the evaluation plan. • Projected Reach and Funding: The plan requests a total of $20,293,924 for FY 2009/2010 for the INN Plan. Specific funding amounts are allocated to the different UREP groups within the ISM model based on factors like poverty, prevalence, and penetration rates. The Community-Designed ISM Model aims to serve 1,400 families annually (2,800 individuals over two years of initial funding). The Integrated Peer-Run Model aims to serve 516 clients annually. The Integrated Mobile Health Team Model is estimated to serve 900 individuals and their families annually. • Learning Objectives and Evaluation: The plan is framed as a “learning grant.” Evaluation measures are outlined, including tracking client outcomes, assessing the effectiveness of non-traditional community-based providers, identifying and addressing barriers to implementation, and evaluating stakeholder satisfaction. The ISM model aims to learn about leveraging community resources and the actual cost of delivering integrated, culturally competent care. Source 2: “oceanREmixEDscreenplay3-2.pdf” and “outline NovationMotivationByOceanDuran.pdf” by Ographer Ocean Duran Main Theme: Exploring the relationship between art, life, personal experience, and the development of skills and wisdom through a process of self-discovery, environmental interaction, and production. Most Important Ideas/Facts: • Artistic Mission and Social Realism: The artistic mission is described as “Art imitating Life~2,” utilizing “the greatest philosophical resource that we have in our societies… our ability for stimulating our environment.” This leads to understanding relativity and forming correlating activities based on individual values. The concept of “Social realism” is introduced as the “use of realistic portrayals of life in art or literature to make a social or political point.” • Individual Resourcefulness and Environmental Interaction: The work emphasizes the individual becoming “self reliant by creating (for himself) a resourceful plan to EXECUTE PRODUCTION.” This resourcefulness is then applied to interacting with the environment, identifying contrasting elements within oneself and the environment, leading to a “design of discovery” and a “more accommodating reality.” • Methodology and Support Systems: The proposed methodology involves “Universal design or a structured formation in which, by process of elimination, will prove the designs absolution.” Support systems are built by developing skills that utilize one’s “talents and experiences to perform and provide educational material that supports the design.” • Communication and Process: The value of expression is perceived through the “communicative value of process.” Principles involved in this environment “find purpose in the process of communication by utilizing individualism and it’s coherent design of universal relativity.” • Production of Wisdom: The process of production, especially one that involves the community, is seen as generating wisdom. “WHAT IS GAINED THROUGH THESE STUDIES, PROVES TO BE MORE THAN A SKILL THAT IS PRACTICED because of the correlative design and provides a system (expressing) the wisdom that develops during the production.” Wisdom is seen when objectives are clear and components find their “correlative usage within the infrastructure that shows it’s environmental impact among the other components.” • Contrasting Elements and Distance vs. Hierarchy: Learning is facilitated by “showing them first the elements TO CONTRAST AND BRING FORTH DIFFERENCES by researching other methods of measurement which measure DISTANCE INSTEAD OF HIERARCHY, (thus showing) it’s structure of process.” • Rhythm and Pattern: Rhythm is described as most noticeable when individuals are “in ‘sync’ with either past experiences or by environmental impact.” Understanding rhythm is a “form of wisdom that one can easily understand when they experience a situation that they have been able to surpass by observation.” “Patterns” are identified as a “medium” or connecting component recognized because they conform to “our own personal methods to successfully achieve principals in which we conduct our lives.” • Business Models and Serving the Consumer: Business models are designed to “serve the consumer based on what has already been established.” This involves creating an initial product of interest and then developing “accessories” to reach a broader market. The goal of a product or purchase is movement; if it’s “still,” action is needed to involve the customer. • Human Capital and Innate Ability to Adapt: Personal directives identify strengths and weaknesses for procurement, focusing on “Human capital gain and increase” and the “Learning an innate ability to adapt in a situation by propositioning artistic methods as a practical” skill. • Critical Resource Functionality and Systematic Resourcing: The philosophy of the “biz” involves “Strategic Implements” (entertainment, funding, re-establishment of learning) and “Systematic Resourcing” which includes “Performance Production” and a “Resourcing process to help remedy a cause.” • Existence and Innovation: Existence is seen as living “based on the notion of how it relates in purpose to how it lives ‘now’ in its meaning or by how it comes to stand.” Systematic resourcing and performance production are a “basis on what surrounds the centralized focus of the current, greater formation produced naturally for remedial needs or innovation to the standard.” • Value of Community Production: A production involving its community creates a process that can “service the community so that it engages other sources, not usually associated to it.” This is achieved by adhering to the strengths of each identity within the community. • Proposed Services and Needs: The proposed services are described as a “specialized ability correlative to the educative up-bringing as an innovative and motivative Muse!” The needs and opportunity identified are “To bring forth core philosophical strategies and movement within that has acquired the applicable skills to “know how to move it on out”.” Overlap and Potential Connections: While the LACDMH document focuses on a large-scale public mental health system and the Duran documents explore a more personal, artistic, and philosophical approach, several potential areas of connection and overlap exist: • Innovation and Learning: Both sources emphasize innovation as a process of learning and exploration. The LACDMH plan is a “learning grant,” and Duran’s work is centered on developing skills and wisdom through experience and production. • Addressing Unmet Needs: The LACDMH plan explicitly addresses the unmet mental health needs of specific vulnerable populations. Duran’s work, through the concept of “Systematic Resourcing” and a “Resourcing process to help remedy a cause,” suggests a framework for addressing needs through creative production and community engagement. • Community Engagement and Collaboration: The LACDMH Community-Designed ISM model is heavily reliant on the “collective wisdom” and collaboration of UREP communities. Duran’s concept of a “production that involves its community” and engaging “other sources” aligns with this emphasis on community involvement. • Value of Lived Experience: The LACDMH Integrated Peer-Run Model is founded on the principle of utilizing individuals with “lived experience of mental health issues.” Duran’s work also emphasizes the value of individual experience, personal assessments, and developing skills through lived situations (“experience a situation that they have been able to surpass by observation”). • Holistic and Integrated Approaches: The LACDMH models aim for integrated care across mental health, physical health, and substance abuse, as well as connecting with non-traditional supports. Duran’s concept of “Art imitating Life” and the interconnectedness of elements within an environment suggest a holistic perspective on human experience and well-being. • Process and Design: Both sources highlight the importance of process and design. The LACDMH plan outlines specific models and implementation timelines, while Duran’s work explores “Program Planning Models,” “framework ‘design’,” and the “structure of process.” In conclusion, the LACDMH document provides a concrete example of a large public system attempting to innovate to address complex social and health issues through structured programs and community collaboration. The Duran documents offer a more abstract and philosophical exploration of personal innovation, the role of art, and the process of creating value and wisdom through self-reliance, environmental interaction, and collaborative production. Juxtaposing these sources reveals potential intersections in their shared emphasis on the value of experience, community, process, and the pursuit of positive outcomes, whether those outcomes are improved mental health access or the development of personal and collective wisdom. ——————————————————————————– LA Mental Health Innovation Plan: Timeline and People Here is a detailed timeline and cast of characters based on the provided sources: Timeline of Events • Early May 2009: The extensive and intensive planning process for the Los Angeles County Department of Mental Health (LAC-DMH) Mental Health Services Act (MHSA) Innovation (INN) Plan begins. • February 18, 2009: The Los Angeles County MHSA Stakeholder Delegates endorse a process that focuses the Innovations Plan on three critical questions: the fraying safety net for the uninsured, fragmentation of services, and decreased capacity to serve uninsured clients due to shrinking County General Funds. They also prioritize specific populations: the uninsured, homeless, and Underrepresented Ethnic Populations (UREP). • May 19, 2009: Funding for Innovations planning is assured following an election, allowing the planning process to pick up in earnest. • June 24, 2009: The MHSA Stakeholder Delegates approve a planning structure for the Innovations Plan, including broad public input, work groups focused on target populations, and the inclusion of consumers, family members, parents, and caregivers in formal decision-making roles. • September 25, 2009: The MHSA-Innovations (INN) Strategies Submission Log is compiled, listing various proposed strategies from different submitters and identifying which target populations (Homeless, Uninsured, UREP) they address. This log includes a diverse range of initiatives from various organizations and individuals. • October 20 – November 19, 2009: A 30-day public comment period for the LAC-DMH MHSA Innovation Plan is completed. • November 19, 2009: A Public Hearing for the LAC-DMH MHSA Innovation Plan is hosted by the Los Angeles County Mental Health Commission. Comments and questions are received and audio recorded, with a typed transcriber for accuracy. • November 24, 2009: Projected Revenues and Expenditures for Work Plan #1 (Integrated Clinics Model), Work Plan #2 (Integrated Mobile Health Team Model), and Work Plan #4 (Peer-Run Model) are prepared by Ansara J. Lewis. • November 25, 2009: The Innovation Work Plan Narrative for the Integrated Peer-Run Model (Work Plan #4) and the Community-Designed Integrated Service Management Model are dated. • December 1, 2009: The County of Los Angeles Department of Mental Health formally submits a request to amend its MHSA Agreement to include an increased level of funding for Fiscal Year 2009-2010. The submission includes the LAC-DMH MHSA Innovation Plan and requests $20,293,924 for FY 2009/2010. • January 2010 (Estimated): Estimated Plan Approval from the California Department of Mental Health. • February – April 2010: Competitive Bidding Process for the Innovations Plan projects is scheduled to take place. • May – July 2010: Contract Negotiations, Board Approval, and Awarding of Contracts for the Innovations Plan projects are scheduled to take place. • August – October 2010: Start up and Staffing of ISM Teams (Community-Designed Integrated Service Management Model) and Peer-Run Models are scheduled to begin. This includes training of culturally diverse staff for the Peer-Run Models. Monitoring and review of participating community-based partner providers for the ISM Teams will also begin. • November 1, 2010: The 1st Quarterly Formative Evaluation and Reporting for the ISM Model is scheduled. This involves identifying, monitoring, and addressing barriers to implementation. • November 2010 – January 2011: Outreach, Engagement, Linkage, Education, and Training activities for the ISM Model are scheduled. Evaluation of essential components for successful culturally-informed peer-based facilitation will also occur. • February – May 2011: ISM Services are scheduled to be Provided to Families. • June 1, 2011: The 3rd Quarterly Formative Evaluation and Reporting for the ISM Model is scheduled. This includes measuring service completion rates, evaluating non-traditional providers, assessing barrier reduction, and determining if community needs are being met. • June 2011 – August 2012: ISM Services continue to be Provided to Families. Information on the number of non-traditional community-based partners providing services will be gathered. • September – December 2012: Summative Evaluation/Final Report for the ISM Model is scheduled. Results and learnings will be shared with various audiences. • Unknown Date (post-2012): Ocean Duran creates “MasterPiece N’Mocean” (by Ographer Ocean Duran), a screenplay or artistic work that incorporates themes of artistic mission, social realism, resourcefulness, personal purpose, methodology, support systems, implications of skill development, universal design, and wisdom gained through production. • Unknown Date (post-2012): Ocean Duran creates the “outline NovationMotivationByOceanDuran.pdf,” which details his artistic mission, program planning model (NovationMotivation), impact assessment, scientific and design methods, timeline concepts related to movement and consumer engagement, personal directives, critical resource functionality (including performance production and remedying a cause), and systematic implements for program development. Cast of Characters • Marvin J. Southard, D.S.W.: Director of the County of Los Angeles Department of Mental Health (LAC-DMH). • Roderick Shaner, M.D.: Medical Director of the County of Los Angeles Department of Mental Health (LAC-DMH). • Robin Kay, Ph.D.: Chief Deputy Director of the County of Los Angeles Department of Mental Health (LAC-DMH). • Gladys Lee, LCSW: District Chief of the LAC-DMH Planning Division. She is the point of contact for questions, comments, and revisions requests regarding the MHSA Innovation Plan submission. • Los Angeles County MHSA Stakeholder Delegates: A countywide, diverse, and representative group specifically created to ensure wide and meaningful public participation in ongoing MHSA planning. They were instrumental in endorsing and approving the planning process and structure for the Innovations Plan. • Jerry Lubin: Chair of the Los Angeles County Mental Health Commission who chaired the Public Hearing on the Innovations Plan. • Rigo Rodriguez: Facilitator of the Public Hearing on the Los Angeles County Department of Mental Health Innovations Plan. • Ansara J. Lewis: Prepared the Innovation Projected Revenues and Expenditures for several Work Plans in the LAC-DMH MHSA Innovation Plan. • Ocean Duran: Artist, Ographer, and creator of the screenplay “MasterPiece N’Mocean” and the outline “NovationMotivationByOceanDuran.pdf”. His work explores themes of artistic mission, social realism, innovation, motivation, and systematic approaches to production and personal development. He is also associated with “oceanremix@yahoo.com” and “oceanduran copyright2012”. • Peggy Edwards: Submitter of two strategies listed in the MHSA-Innovations (INN) Strategies Submission Log: “ACE Study-Based System of Primary Medical Care, Supportive Services, and Health Education” and “Vulnerable Veterans Initiative”. • AFSCME: Submitter of two strategies listed in the MHSA-Innovations (INN) Strategies Submission Log: “Advocacy to Increase Ease/Flexibility of attempting employment for persons with disabilities” and “Seeking substance abuse treatment for individuals receiving Section 8 housing”. • James Randall: Associated with DMH and submitted strategies including “Consumer and Family” and “Recovery After Initial Schizophrenia Episode (RAISE) Program”. • Stars, Inc: Submitter of the strategy “Core Gift Coorporation with Sol Adventurers Foundation”. • Black Los Angeles County Client Coalition (BLACCC): Submitter of the strategy “Cross-Sector Collaborative Project”. • Inner City Industry (ICI): Submitter of the strategy “Dedication to Education Street Team Mentor Program”. • Heritage Clinic: Submitter of the strategy “Developing an Evidenced Based Practice for Ethnic Psychotic Elders”. • DPSS: Submitter of the strategy “DPSS/DMH Collaboration to Transition GR NSAs to SSI”. • CONNECTING – it works! Inc: Submitter of the strategy “Dr Floyd McGregor’s Chill Out CBT Anger Management Program”. • Tarzana Treatment Centers: Submitter of strategies including “Integrated Care for Consumers with Co-Occurring Disorders”, “Medication-Assisted Therapy with Vivitrol for Alcohol Dependent, Trauma-Exposed COD Individuals”, and “School Based Mental Health and Substance Abuse Prevention”. • Don Parrington: Submitter of the strategy “Integrated Dual Disorder Treatment Quality and Access Improvement”. • SF Valley Community Mental Health Center: Submitter of the strategy “Integrated Healthcare, Mental Health, SA Services to Homeless Mentally Ill”. • Didi Hirsch Mental Health Services: Submitter of strategies including “Integrated Primary and Behavioral Healthcare for Mental Health Consumers” and “Trauma Informed Afterschool Program for Middle School Students”. • Mandy Johnson: Submitter of the strategy “Integrated School Health Center”. • Mollie Lowery: Submitter of strategies including “Integrated Supportive Housing Management” and “Project to Access and Sustain Permanent Housing (PAS)”. • Community Clinic Association of LA: Submitter of the strategy “Integrating Behavioral Health into the Medical Home”. • LA Gay & Lesbian Center: Submitter of strategies including “Life Works LA” and “Stop LGBTQ Family Violence”. • Long Beach TAY Collaborative: Submitter of the strategy “Long Beach TAY Collaborative”. • Step up on Second: Submitter of strategies including “Low Barrier Drop In Center for Homeless TAY” and “Volunteer Companions”. • Community Family Guidance Center: Submitter of the strategy “Marketing Fiscal Sources for DMH programs to School Officials”. • Mary Lind Recovery Centers: Submitter of the strategy “Mary Lind COD Integration Strategy”. • DMH-Older Adult Programs Admin: Submitter of strategies including “Older Adult UREP Peer Support Project” and “Primary Care-Based Telepsychiatry”. • Latino UREP: Submitter of the strategy “Ourtreach, Linkage and Education-OLE”. • Para Los Ninos: Submitter of the strategy “Para Los Ninos Mental Health Collaborative Care Model”. • Child Care Resource Center (CCRC): Submitter of the strategy “Parents and Child Care Providers Working Together for the Future”. • Project Return: Submitter of the strategy “Peer-Run Respite House Project”. • Kedren Community Health Center: Submitter of the strategy “Pilot Integrating Health, Mental Health and Supportive Services to Head Start Families”. • Skid Row Housing Trust: Submitter of the strategy “Project-Based Service Vouchers (PBSV)”. • California Healthy Marriages Coalition: Submitter of the strategy “Promoting Mental Health through Healthy Relationship Skills”. • Prototypes: Submitter of the strategy “PROTOTYPES Center for Innovation and Integration”. • Armenian Relief Society of West USA: Submitter of the strategy “Reach Out to At-Risk, Trauma Exposed Families”. • Diane McNeal: Submitter of the strategy “Regenerative Transitional Behavior Therapy (RTBT-T)”. • EE/ME UREP: Submitter of the strategy “Outreach and Referral Center for Multicultural Mental Health Services”. • Children’s Institute: Submitter of strategies including “Responding to Domestic Violence: The “Whole Person” Approach”, “Trauma Systems Therapy for Substance Abusing Adolescents and Transitional Age Youth”, and “Wellness on Wheels”. • LA Child Guidance Clinic: Submitter of strategies including “Salud Y Familia Media Campaign” and “The Three R’s – Building Relationships, Resiliency & Recovery”. • Vista Del Mar Child and Family Services: Submitter of the strategy “Secure Attachment for Family Engagement (SAFE)”. • Special Service for Groups: Submitter of the strategy “SPA 6 Restoration Center (S6RC)”. • Laurel Bear, Rosalie Finer-Alliant Int.: Submitters of the strategy “Steps to Success”. • Family Service: Submitter of the strategy “Strength Through Access and Resources (STAR)”. • LBHI: Submitter of the strategy “System Development: Mental Health, Substance Abuse, and Health Program”. • Antelope Valley Partners for Health: Submitter of the strategy “Teachers and Life Coaches (TLC)”. • AI UREP: Submitter of the strategy “The Restoring Urban Traditional Healing (RUTH) Project”. • SCHARP: Submitter of the strategy “The SHARE Program”. • Therese Haviland: Submitter of the strategy “Therese Haviland’s CBT Langauge Arts Therapy”. • Children’s Hospital: Submitter of the strategy “Understanding and Addressing Homelessness in the Context of Trauma”. • Choices Recovery Services: Submitter of strategies including “Video Conference Technology Field based Psychiatric Services” and “Youth Outreach Trailer to deliver PEI Mental Health Services”. • Kathy Millet: Submitter of the strategy “Advancing the Transition to Adulthood Among Older Youth and Young Adults with MH Needs and Fragile Community Connectedness (Advancing Pathways to Success)”. • DMH – EAD: Submitter of several strategies including “Hire Staff to Assist Under-Age (less than 60) Hoarders”, “Peer-Run Crisis Residential Program”, “Procovery”, “Peer Support Strategies For Consumers”, and “Collaborative Care Strategy for Consumers”. • Ruth Hollman: Submitter of the strategy “Provide Support for People with Mental Health Problems”. • Consumers, Families, Parents, and Caregivers: Integral participants in the planning process of the MHSA Innovations Plan, providing input and holding formal decision-making roles. They are also the primary recipients of the services proposed in the plan. • Underrepresented Ethnic Populations (UREP) Subcommittees: Five distinct subcommittees representing African Immigrant/African American (A/AA), American Indian (AI), Asian Pacific Islander (API), Eastern European/Middle Eastern (EE/ME), and Latino communities. They provided crucial input and wisdom for the development of culturally competent approaches in the Innovations Plan, particularly the Community-Designed Integrated Service Management Model. • Community-Based Partner Providers: Organizations and providers that will potentially contract with LAC-DMH to implement the Innovations Plan projects, particularly the Integrated Service Management (ISM) and Peer-Run Models. • Non-traditional Community-Based Providers: Partners who will provide services within the ISM model, likely rooted in specific ethnic communities and drawing upon cultural norms and resources. • Integrated Mobile Health Team: A multidisciplinary team proposed in one of the Innovations Plan models, including physical health, mental health, and substance abuse professionals and specialized staff. They would provide integrated services to homeless individuals. • Peer Specialists (“bridgers”, advocates, supporters): Individuals with lived experience of mental health issues who will primarily support their peers in the Integrated Peer-Run Model. • Family Specialists: Individuals whose family members have had mental health issues, functioning as support for families in crisis within the Peer-Run Model. • Parent Partners: Parents/caregivers with children who have had mental health issues, functioning as support for other parents/caregivers in crisis with children who have mental health issues within the Peer-Run Model. • The “Spirit of God”: A character mentioned in the excerpt from Genesis 1, described as hovering over the waters in the beginning. • God: The creator figure described in the excerpt from Genesis 1, responsible for the creation of the heavens and the earth, light, sky, land, seas, vegetation, lights in the sky, living creatures in the water and sky, livestock, creatures on the ground, wild animals, and mankind. ——————————————————————————– Mental Health Innovation and Human Capital Development Innovations in Mental Health and Artistic Expression Quiz 1. What is the primary purpose of the MHSA Innovations (INN) Plan in Los Angeles County, as stated in the document? 2. What are the three critical issues the LAC-DMH MHSA Stakeholder Delegates prioritized for attention through innovative strategies? 3. Name three of the five Under-Represented Ethnic Populations (UREP) subcommittees identified in the LAC-DMH plan. 4. Describe the core concept of the Integrated Service Management (ISM) Team within the Community-Designed ISM Model. 5. What are Peer-Run Crisis Houses designed to provide as an alternative to hospitalization? 6. How does the Community-Designed ISM Model propose to address disparities in access to mental health services for UREP communities? 7. According to the “oceanREmixEDscreenplay3-2.pdf,” what is considered the “greatest philosophical resource that we have in our societies”? 8. In the context of the “outline NovationMotivationByOceanDuran.pdf,” what is the significance of finding contrasting elements within an individual and utilizing their environment? 9. What does the “outline NovationMotivationByOceanDuran.pdf” suggest is gained through the studies and production process described? 10. Based on the “outline NovationMotivationByOceanDuran.pdf,” what does “Human capital gain and increase” represent within the framework of personal directives? Answer Key 1. The primary purpose of the MHSA Innovations (INN) Plan is learning, focusing on identifying new practices to increase the array of creative and effective approaches for mental health services. 2. The three critical issues are the fraying safety net for the uninsured, fragmentation of services (mental health, health, substance abuse), and decreased capacity to serve uninsured clients due to shrinking County General Funds. 3. African/African-American, American Indian, Asian/Pacific Islander, Eastern European/Middle Eastern, and Latino. (Any three of these are acceptable). 4. The ISM Team is a multidisciplinary health team that works under one agency or supervision to provide integrated health, mental health, and substance abuse services with client-centered goals. 5. Peer-Run Crisis Houses are designed to provide a warm, safe, welcoming environment for uninsured people in psychiatric distress who are not a danger to others, serving as alternatives to hospitalization. 6. The Community-Designed ISM Model seeks to bridge the gap between ethnic communities and formal care providers by allowing communities to direct how services are integrated into trusted institutions and utilizing community-specific peer-based outreach. 7. The “greatest philosophical resource” is our ability for stimulating our environment, which leads to foundations of relativity and the formation of correlating activities. 8. Finding contrasting elements and utilizing the environment is part of the relation process, which develops a design of discovery that allows an individual to see beyond social obstacles and understand a more accommodating reality. 9. Through these studies and production, more than just a practiced skill is gained; it provides a system for expressing the wisdom that develops during the production process, where objectives become clear through correlative usage. 10. “Human capital gain and increase” represents the strengthening and expansion of an individual’s abilities, knowledge, and skills as a result of the processes and learning described, contributing to their overall worth and capacity. Essay Format Questions 1. Analyze the different innovative models proposed in the LAC-DMH MHSA Innovation Plan. Discuss how each model attempts to address the identified critical issues and serve the target populations, highlighting their unique features and potential benefits. 2. Evaluate the role of stakeholder input, particularly from Under-Represented Ethnic Populations (UREP) communities, in the development and implementation of the Community-Designed Integrated Service Management (ISM) Model. How does this input shape the model’s principles and intended outcomes? 3. Compare and contrast the Integrated Peer-Run Model and the Community-Designed Integrated Service Management Model. Discuss their similarities in goals and differences in approach, particularly concerning the roles of peers and community involvement. 4. Explore the concept of “systematic resourcing” as presented in the “outline NovationMotivationByOceanDuran.pdf.” How does this concept relate to problem-solving and innovation within the context of the provided texts, and what are its implications for achieving desired outcomes? 5. Discuss the intersection of artistic mission, personal development, and community engagement as presented across the provided sources. How do the ideas of self-reliance, environmental stimulation, and the utilization of individual talents contribute to both personal and societal progress? Glossary of Key Terms • Community-Designed ISM Model: An innovative model in the LAC-DMH plan that builds on community strengths, especially in underserved ethnic communities, to integrate health, mental health, substance abuse, and other needed care through collaboration between regulated entities, contract providers, and community-based organizations. • Correlative Practices/Correlative Design: Methods or structures that allow for the measurement of personal success or demonstrate a system of wisdom development by relating different elements or aspects. • Harm Reduction: Strategies designed to reduce the risk of harm associated with certain behaviors, such as drug abuse. • Holistic Support: A comprehensive approach to assisting clients that addresses not only their health, mental health, and substance abuse needs but also other services like transportation, follow-up, encouragement, and communication, often in a culturally and linguistically competent manner. • Human Capital: The skills, knowledge, and experience possessed by an individual or population, viewed in terms of their value or cost to an organization or country. In the context of the source material, it relates to gaining and increasing these attributes. • Integrated Mobile Health Team: A multidisciplinary health team (including mental health, physical health, and substance abuse professionals, as well as specialized staff like housing/employment specialists and peer/family advocates) that provides services to homeless individuals and those in Permanent Supportive Housing (PSH). • Integrated Peer-Run Model: An innovative model utilizing peer support to identify, obtain, and coordinate mental health, physical health, and substance abuse care for uninsured individuals, reducing system fragmentation. It includes strategies like Peer Run Integrated Services Management (PRISM) and Peer-Run Crisis Houses. • Innovation (INN) Plan (MHSA): The final plan component of the Mental Health Services Act in LA County, focused on learning and identifying new practices to increase creative and effective approaches for mental health services. • Mental Health Services Act (MHSA): California legislation that provides funding for expanded county mental health services. The Innovations (INN) Plan is a component of MHSA. • Peer Advocates/Peer Specialists: Individuals with lived experience of mental health issues who provide support, information, motivation, and encouragement to their peers, often assisting with service access and communication. • Peer-Run Crisis Houses: Client-driven, holistic alternatives to hospitalization designed to provide a safe and welcoming environment for uninsured individuals experiencing psychiatric distress who are not a danger to others. • Peer Run Integrated Services Management (PRISM): A client-driven, holistic alternative within the Integrated Peer-Run Model that allows uninsured peers to secure needed physical health, mental health, and substance abuse options as part of a program designed and run by people with lived experience. • Permanent Supportive Housing (PSH): Housing units dedicated to serving the MHSA focal population, often with project-based service vouchers that provide access to integrated support services. • Provisionary Management: A concept described as involving Lingo, Location, and Lending, suggesting a preparatory or qualifying approach to management. • Project-Based Service Vouchers (PBSV): Vouchers committed to housing developers interested in building PSH units, used to leverage housing capital and indicate developer access to integrated services provided by an Integrated Mobile Health Team. • Recidivism: The tendency of a convicted criminal to reoffend. In the context of mental health services, it might refer to individuals dropping out of services or experiencing recurring crises. • Rhythm Patterns N’Mocean (RPM): A concept related to situational events recalling chronological events that direct movement (“M’ocean”) for evidential outcomes, often recognized through patterns that conform to personal methods and principals. • Social Realism: The use of realistic portrayals of life in art or literature to make a social or political point. • Speech Acts Theory: A linguistic theory that analyzes how utterances are used to perform actions, often combined with probability theory to assess behavior. • Stakeholder Delegates (MHSA): A countywide, diverse, and representative group specifically created to ensure wide and meaningful public participation in ongoing MHSA planning in Los Angeles County. • Systematic Implements: Defined as systematic observations of formational elements for progression in the learning curve, applying elemental structure according to artistic plans, and formulating business definitions. • Systematic Resourcing: A basis for understanding what surrounds a centralized focus for remedial needs or innovation, involving performance production and a resourcing process to help remedy a cause. • Under-Represented Ethnic Populations (UREP): Communities that have been historically on the periphery of the mental health system, identified in Los Angeles County as African Immigrant/African American, American Indian, Asian Pacific Islander, Eastern European/Middle Eastern, and Latino. • Universal Design: A structured formation or processing method that, by process of elimination, aims to prove the absolution of designs. • Vulnerability Index (Common Ground): A method used to assess the vulnerability of homeless individuals, often determining those most likely to die within the next year based on disabling conditions. ——————————————————————————– Purpose of the Integrated Clinic Model Based on the sources provided, the purpose of the Integrated Clinic Model within the LAC-DMH Innovations Plan is multifaceted, aligning with the overall goals of the plan [1, 2]. The primary purpose for the entire Innovations Plan, selected through a stakeholder process, is to Increase the Quality of Services, including Better Outcomes [1-5]. The stakeholders determined that successfully healing system fragmentation is a major impediment to service quality and good outcomes, making this the highest priority [1-5]. The Integrated Clinic Model specifically addresses this by seeking to increase the quality of care and services for its target populations by reducing the fragmentation inherent in the current system of care [2, 6-8]. It aims to achieve this by combining physical health, mental health, and substance abuse services in community-based sites, such as primary care or mental health clinics [6, 7, 9-11]. This is intended to more fully address the spectrum of needs of individuals who are homeless, uninsured, and/or members of under-represented ethnic populations (UREP) [9-11]. Key aspects of the Integrated Clinic Model’s purpose derived from the sources include: • To increase access to mental health, physical health, and substance abuse services for those for whom services are fragmented and resources limited [9-11]. The “no wrong door” approach is used, meaning clients can access the full suite of services by engaging a provider in any of the three disciplines at a single site [12, 13]. • To increase the quality of services, including achieving better physical health and mental health outcomes, by having providers work together to coordinate care across practices [9, 10]. This involves using a multidisciplinary team approach to address the client as a whole, avoiding silos, duplication, and fragmentation [6, 14]. Potential increased quality of care and service and improved clinical outcomes are seen as inherent in an integrated care model [8]. • To provide a “home” for people seeking integrated care [2, 6, 7]. • To support the capacity of primary care or mental health clinics to integrate on-site mental health, physical health, and substance abuse treatment services in an effective, culturally-relevant, and consumer-driven manner [2, 6, 7]. This includes ensuring culturally and linguistically competent care [6, 15-18]. • To improve access and eliminate the stigma often experienced while seeking care at mental health-only sites by integrating services at primary care sites [8, 19, 20]. Integrating physical health services into mental health settings is also intended to increase access for clients with serious mental illness into physical health care [19, 20]. • To create an efficient and cost-effective system by utilizing existing infrastructure and leveraging other programs [9, 10]. Care coordination aims to facilitate access for high-risk populations, promote coordination across organizations and providers, ensure care at the appropriate level, and contain costs [21]. The goal is to deliver services in a cost-effective way [22, 23]. • To promote interagency collaboration between Los Angeles County departments and providers [9, 10]. • To focus on wellness in all disciplines [15, 18, 20]. • To reduce disparities in access to mental health and physical health services [19]. • To use data to drive outcomes, improve systems, and achieve client-centered results [18, 24, 25]. This includes using disease management software for quality improvement [26, 27] and tracking outcomes using a standardized electronic integrated care plan [26, 28]. In essence, the Integrated Clinic Model is designed to test if integrating mental health, physical health, and substance abuse services at community sites can effectively overcome system fragmentation, improve the quality and accessibility of care, lead to better outcomes for vulnerable populations, and do so efficiently and cost-effectively [2, 6-11, 23]. ——————————————————————————– Innovative Mental Healthcare for Underserved Populations Based on the sources, the Los Angeles County Department of Mental Health (LAC-DMH) Innovations Plan specifically focuses on addressing the needs of underserved groups [1-5]. The plan identifies three critical populations requiring attention through innovative strategies: the uninsured, homeless, and underrepresented ethnic populations (UREP) [6]. Under-Represented Ethnic Populations (UREP) are a key focus and include specific communities such as African/African American, American Indian/Native American, Asian and Pacific Islander, Eastern European/Middle Eastern, and Latino communities [6, 7]. The plan also acknowledges other sub-populations as underserved, such as linguistically-isolated families/individuals [8-10], families/individuals who have not accessed services due to stigma [8-10], families/individuals who have not benefitted from or received inappropriate services [8-10], and uninsured individuals from GLBTQI, Deaf or Hard-of-Hearing, and Blind or Visually Impaired communities [11-13]. Families, parents, and caregivers are also included in the stakeholder groups and target populations [1, 2, 5, 6, 14-17]. Key Issues Faced by Underserved Populations: The sources highlight that current care is fragmented, ineffective, and does not fully meet the needs of communities, particularly for those with minimal resources and high mental health needs [15]. Specific issues and barriers identified include: • Fragmentation of mental health, health, and substance abuse services [1, 3-6, 14, 15, 18-23]. • A fraying safety net due to decreased funding and growth in the number of uninsured persons [6]. • Decreased capacity to serve uninsured clients potentially displaced from services as a result of shrinking County General Funds [6]. • Stigma surrounding mental illness, which is a powerful barrier to seeking treatment [8, 10, 24-27]. Integrating mental health services into primary care settings can help reduce this stigma [24, 25, 28]. • Mistrust and fear of treatment, racism, discrimination, and differences in language and communication, particularly for UREP members [24]. • Lack of access to culturally-appropriate services, services not provided countywide in their language or within a comfortable cultural context, and formal providers not recognizing or knowing how to tap into inherent ethnic community resources [7, 9, 10, 29]. • Geographic boundaries for service delivery that are incongruent with ethnic communities [7]. • For homeless individuals, challenges include a lack of access to healthcare, dental care, mental health care, and drug/alcohol treatment, compounded by the adverse conditions of living on the streets [23]. How the Innovations Plan Addresses the Needs of Underserved Populations: The overarching goal of the plan is to ensure the availability of services to children, youth, adults, and older adults most challenged by severe and persistent mental illness, and to promote recovery [30]. Increasing access to underserved groups is one of the stated purposes of the proposed innovation projects [1-5]. The plan was designed through an extensive community participation process that included stakeholders from diverse groups, such as the MHSA UREP subcommittees and the Homeless Advisory Council [6, 18]. The plan proposes four integration models to address the critical question of what are the most effective models for integrating mental health, physical health, and substance abuse services for the uninsured, homeless, and UREP [14, 31, 32]. These models were specifically designed to be culturally competent and driven by consumers, family members, parents, and caregivers [1-5, 15]. 1. Integrated Clinic Model: This model targets the uninsured, homeless, and UREP by combining mental health, physical health, and substance abuse services in community-based sites like primary care or mental health clinics [2, 15, 19, 21, 24, 33, 34]. This approach aims to increase access by bringing services to locations people already frequent [19, 24, 25, 35] and uses a “no wrong door” approach [24]. It also seeks to increase the quality of services and outcomes [19, 21, 25, 35, 36]. The model’s innovation includes targeting the most vulnerable populations to test if integrated care improves service quality for them [37, 38]. Peers are included as staff [36-40]. 2. Integrated Mobile Health Team Model: Primarily designed for individuals with mental illness who are homeless, including those moving into permanent supportive housing (PSH), many of whom are uninsured and UREP [3, 20, 21, 41-43]. This model addresses the fragmentation of services for the homeless population [20, 35]. It uses a client-centered, housing-first approach with harm reduction strategies [20, 35, 44]. A mobile, integrated, multi-disciplinary team provides outreach and services where clients are located (streets, shelters, PSH) [20, 35]. It offers multiple points of entry based on the client’s identified need (housing, physical health, mental health, or substance abuse) [35, 41, 43]. Innovative funding mechanisms are used, such as project-based service vouchers tied to PSH units, to leverage housing capital and provide ongoing services regardless of residence [35, 41, 45]. 3. Community-Designed Integrated Service Management (ISM) Model: Explicitly focuses on Under-Represented Ethnic Populations (UREP) [4, 7, 9, 10, 21, 22, 33, 35, 46-48]. It addresses fragmentation by building on the strengths of ethnic communities [4, 22, 47] and envisions care defined by the community itself [4, 22, 35, 47]. The model promotes collaboration between formal and non-traditional providers (like faith-based organizations or community healers) and community organizations [4, 22, 35, 46, 47, 49, 50]. It uses culturally competent “service integrators,” including professionals and specially-trained peers, grounded in ethnic communities and their natural support systems [7, 22, 35, 46]. The model differentiates specific needs and approaches for the five distinct UREP communities [7, 22, 46, 48, 51] and utilizes community-designed peer-based outreach, engagement, linkage, education, and advocacy [22, 26, 27, 29, 46, 52-54] to address barriers like stigma and linguistic isolation [7, 8, 10]. Points of entry are through various community sites [8, 12, 22, 55]. Family members are a major focus in this model [8, 10]. 4. Integrated Peer-Run Model: This model supports uninsured adults with mental health needs, including those experiencing a crisis and those who may also be homeless and/or UREP [11, 16, 17, 33, 56]. It provides programs designed and run by people with lived experience of mental health issues (peers) [16, 17, 33]. The model incorporates Peer-Run Integrated Services Management (PRISM) and Alternative Peer-Run Crisis Houses as alternatives to traditional services or hospitalization [16, 17, 33]. PRISM utilizes peer teams to help uninsured peers secure and coordinate physical health, mental health, and substance abuse options based on a “whatever it takes” philosophy [16, 17, 33]. Both strategies are designed to be culturally competent, with support from peers similar linguistically and ethnically [16, 57]. The model aims to reduce fragmentation through a peer-driven approach [5, 17] and expands peer-run options within the public mental health system [16, 17, 33], including peer staffing, administration, and supervision [5, 16]. The plan’s selection of “Increase the Quality of Services, including Better Outcomes” as the primary purpose was determined through a stakeholder process that identified healing system fragmentation, which disproportionately affects underserved groups, as the highest priority [1-5]. LAC-DMH is committed to working alongside ethnic and cultural communities historically on the periphery of the mental health system [9, 48]. ——————————————————————————– Los Angeles County Mental Health Service Challenges Based on the sources, Los Angeles County faces several significant challenges in integrating mental health services with physical health and substance abuse services. A key overarching challenge is the fragmentation of the existing service system [1-13]. This fragmentation is seen as a major impediment to service quality and good outcomes [3], resulting in incomplete or inappropriate treatment for consumers [4]. Specific challenges contributing to this fragmentation and hindering integration include: • Services being located in different settings [5, 14, 15]. • Providers from various agencies working under separate systems, supervisors, regulations, and requirements [6-8]. Previous multi-disciplinary teams were hampered by accountability to different agencies and/or supervisors [7]. • Separate charts and care plans for clients [6, 7]. • Disparate and separate funding streams [6-8, 16-18]. Identifying mechanisms for sustainable funding for integrated programs is a goal and challenge [19-22]. • Limited capacity for communication, coordination, and sharing of information among programs and providers [14, 23]. • Intra-agency disagreements regarding target populations [16]. • Limited referral mechanisms and expertise among providers across different disciplines [16]. Improving provider competency around appropriate referrals is a learning question [24]. • Poorly defined outcome measures [16]. • The complexity of integrating care in a large, complex urban environment that includes both directly operated and contracted entities, especially given its geographic widespread nature [7, 9, 11, 12, 18, 25-30]. The proposed system changes are challenging, and the extent of fragmentation and barriers will not be fully understood until attempted [31]. • Difficulties utilizing existing community resources beyond a specific integrated system [16]. Furthermore, challenges are specific to populations and approaches: • Significant barriers to accessing services for target populations like the uninsured, homeless, and underrepresented ethnic populations (UREP) [32]. These barriers include stigma surrounding mental illness, distinct from issues of cost, fragmentation, and service availability [32]. • Additional barriers deterring members of UREP communities such as mistrust and fear of treatment, racism and discrimination, and differences in language and communication [32]. Challenges exist in providing services countywide in the language and cultural context preferred by these communities [33]. Formal providers have not always recognized or known how to tap into the inherent resources of ethnic communities [33]. • Difficulties in identifying, credentialing, and incorporating non-traditional practitioners into the formal mental health system, as well as developing mechanisms for them to bill for services [34-36]. • Resistance on the part of some people to referring consumers to consumer-run (peer-run) programs [37]. • A lack of alternatives to institutional and costly options like hospitals and Urgent Care Centers for people experiencing a mental health crisis [13]. • Funding gaps exist among existing public service systems that must be addressed to assure high-quality care for homeless mentally ill clients [22]. For example, while financial resources exist for permanent supportive housing development and operating subsidies, there is no dedicated funding source for supportive services [38]. Gaps also exist in allowable Federal Qualified Health Center (FQHC) service funding for fully integrated mobile health services [39]. The County is seeking to address these challenges through the MHSA Innovations Plan, which aims to learn how to best integrate services for vulnerable populations and heal system fragmentation [3, 4, 40]. The plan tests different models to determine effective approaches, including overcoming barriers and reducing fragmentation [18, 31]. ——————————————————————————– Integrating Los Angeles Mental Health Services Based on the sources, Los Angeles County Department of Mental Health (LAC-DMH) is the largest mental health service system in the nation, serving approximately one-quarter of a million residents each year [1]. The department provides a diverse spectrum of mental health services, including assessments, crisis intervention, case management, and medication support in both residential and outpatient settings [1]. Their workforce includes various professionals such as psychiatrists, psychologists, social workers, and mental health consumers [1]. The overarching goal of LAC-DMH’s plans is to ensure the availability of services to children, youth, adults, and older adults most challenged by severe and persistent mental illness and to promote recovery [2]. Key concepts guiding their service delivery include the achievement of positive outcomes, delivery of services in culturally appropriate ways, and addressing disparities in access, particularly for ethnic, cultural, and underserved communities [3]. A primary issue identified in the sources regarding mental health services in Los Angeles County is fragmentation [4, 5]. Mental health, physical health, and substance abuse services are often located in different settings, provided by different agencies under separate systems, supervisors, and regulations [6-8]. This insufficient integration results in incomplete or inappropriate treatment for consumers [4]. The failure to coordinate primary and behavioral health care has led to grave consequences for individuals with serious mental illnesses, including chronic medical conditions and early mortality [9]. A significant number of people in primary care settings also need behavioral health services, yet many who suffer from diagnosable mental disorders do not seek mental health care, or receive it solely from their general physician [9, 10]. The LAC-DMH MHSA Innovations Plan is specifically focused on learning how to address this fragmentation and improve the quality of mental health services for specific populations, namely the uninsured, homeless, and under-represented ethnic populations (UREP) [3, 4, 11]. Stakeholders identified healing system fragmentation, which disproportionately affects underserved groups, as the highest priority [5]. The plan was developed through an extensive community participation process that sought innovative strategies to address fragmentation and deliver recovery-based services [4]. The plan proposes four models designed to integrate mental health services with physical health and substance abuse care: 1. Integrated Clinic Model: Combines mental health, physical health, and substance abuse services in community-based sites like primary care or mental health clinics [4, 10]. This aims to increase access by bringing services to locations people already frequent, reduce stigma associated with formal mental health settings by integrating them into primary care, and improve service quality through coordination [9, 10, 12-14]. The model supports treating serious mental illness within primary care settings [5, 15] and uses a “warm hand-off” approach between providers [16]. It requires licensed mental health providers on site [17, 18]. 2. Integrated Mobile Health Team Model: A mobile, multi-disciplinary team integrates physical health, mental health, and substance abuse services specifically for individuals with mental illness who are homeless or have recently moved into permanent supportive housing [19, 20]. This model addresses the fragmentation specific to the homeless population and provides a client-centered, housing-first approach with harm reduction strategies [21, 22]. It aims to improve mental health outcomes and reduce homelessness [23]. 3. Community-Designed Integrated Service Management (ISM) Model: Explicitly focuses on UREP communities by integrating formal (including mental health) and non-traditional services based on the community’s definition of care [24, 25]. Services are grounded in ethnic communities and their natural support systems [25]. This model addresses specific barriers UREP face in accessing traditional mental health services, such as stigma, mistrust, language differences, and lack of culturally appropriate care [12, 26]. It uses culturally competent service integrators, including professionals and trained peers, and involves community-designed peer-based outreach, engagement, linkage, and advocacy [25, 27-29]. A core principle is that the public mental health system must adopt culturally competent and holistic strategies anchored in UREP communities that complement formal mental health services [30]. 4. Integrated Peer-Run Model: Uses a peer-driven approach to identify, obtain, and coordinate mental health, physical health, and substance abuse care for uninsured adults with mental health needs (including those who may be homeless, UREP, or from other sub-populations) [31-34]. It incorporates Peer-Run Integrated Services Management (PRISM) as a client-driven alternative to traditional community mental health services and Alternative Peer-Run Crisis Houses as alternatives to hospitalization for mental health crises [32, 34-36]. The model aims to more effectively integrate peer-run programs into the public mental health system [32, 36]. Peer teams coordinate the provision of clinical services [34]. Specific challenges related to integrating mental health services highlighted in the sources include: • Working across different settings, systems, and agencies [6-8]. • Limited capacity for communication, coordination, and information sharing among programs and providers [37]. • Integrating disparate funding streams for sustainable programs [37-40]. • Difficulties incorporating non-traditional practitioners, such as American Indian healers, into the formal mental health system regarding credentialing and billing [41-43]. • Stigma surrounding mental illness and mistrust of formal treatment settings, particularly within UREP communities [12, 26, 44]. • Providing culturally and linguistically competent mental health services countywide [26, 45]. • A lack of alternatives to costly institutional options for people experiencing a mental health crisis [32, 36]. • Difficulties fully integrating peer-run programs into the public mental health system [32, 36]. • Addressing funding gaps, such as the lack of dedicated funding for supportive services in permanent supportive housing for the mentally ill homeless [40]. The Innovations Plan aims to learn how to overcome these barriers [42, 43, 46-49]. Evaluation of the models will assess the extent of integration achieved, service levels and access to mental health services, quality of care and outcomes (including mental health outcomes), stakeholder satisfaction (including clients and providers), and cost-effectiveness [8, 14, 39, 46, 47, 50-57]. The learning questions specifically address aspects like the effectiveness of integrated models for treating individuals with mental health needs alongside other conditions, utilizing ethnic community resources, the role of peers, and the impact on stigma [38, 41, 44, 51, 53, 58-65]. Ultimately, the plan seeks to inform future system changes to better serve vulnerable populations with mental health needs [11, 60]. NotebookLM can be inaccurate; please double check its responses. ——————————————————————————– Lived Experience Informs Mental Health Innovations Based on the sources and our conversation, your query highlights a key aspect of how Ocean Duran’s perspective, informed by lived experience, could be vital for the Los Angeles County Department of Mental Health (LAC-DMH) Innovations Plan. While the provided sources do not contain information about Ocean Duran’s specific experience of homelessness for 8 years in Santa Monica or receiving help from Venice Family Clinic and OPCC, they do discuss the value of “lived experience” and explicitly include the homeless population as a target group for the Innovations Plan models [1-27]. Ocean Duran’s awareness of the lived experience of homelessness, as discussed in the sources, can be vital for several reasons in the context of the LAC-DMH plan: 1. Informing the Value of Lived Experience in Service Delivery: The LAC-DMH plan, particularly the Integrated Peer-Run Model, is explicitly designed to be run by “people with lived experience of mental health issues” [13, 19, 28, 29]. The plan recognizes the critical role peers play in supporting recovery and navigating services [19, 28-39]. Duran’s own work emphasizes utilizing individual talents and experiences [40] and using “his own experiences to relate” [41]. This aligns perfectly with the plan’s intent to leverage the unique insights and empathy that come from having navigated similar challenges. 2. Understanding System Fragmentation: The LAC-DMH plan identifies system fragmentation as a major impediment to service quality and good outcomes, making it the highest priority to address [6, 9, 12, 13, 42]. Duran’s work, as interpreted in the podcast, puts a massive emphasis on understanding processes and workflows [43] and seeking to create “qualitative resolve” through structured components [44]. A person who has experienced this fragmentation firsthand, as Duran did during 8 years of homelessness seeking help, has a deep, practical understanding of the barriers [8] (like separate funding streams, intra-agency disagreements, limited referral mechanisms [45]) that the Integrated Clinic [7], Integrated Mobile Health Team [10], and other models aim to overcome [2-4, 6, 9, 12, 13]. This awareness can inform the design of solutions that truly work on the ground. 3. Enhancing Peer Support and “Peer Bridger” Roles: The podcast specifically connects Duran’s focus on utilizing individual talents/experiences to the peer-run model and community-designed approach [40]. It further links Duran’s focus on peer-to-peer dynamics and valuing lived experience to the concept of “peer bridgers” in the county plan, suggesting his perspective could offer practical insights for strengthening these roles [46, 47]. Peer bridgers help clients navigate the system [46], and someone with direct, successful experience doing so is uniquely positioned to understand what makes these roles effective. 4. Focusing on “Directional Movement” Towards Recovery and Housing: Duran’s “Reaching for the Stars” concept is described as a “remedial component to what lacks in the present recession, directional movement” [44]. Achieving housing after 8 years of homelessness is a clear example of significant “directional movement” towards stability and recovery. The Integrated Mobile Health Team Model specifically uses a “housing-first approach” [3, 10, 17, 23, 27, 48, 49] with the primary goal of addressing fragmentation for the homeless population and providing the supports necessary to secure and retain housing [10, 23, 48, 50-53]. Duran’s lived experience of successfully navigating this journey underscores the importance of such targeted “directional movement” and can inform strategies for supporting others in achieving similar outcomes. 5. Contributing to Outcome Measurement and Quality Improvement: The LAC-DMH plan prioritizes increasing the quality of services and achieving better outcomes [6, 9, 12, 13, 22, 42]. Duran’s work, in the context of “Novation Motivation,” discusses assessing impact [47] and aiming for “qualitative resolve” [44]. His successful experience highlights a vital outcome (housing stability) and the complex journey to get there, which can provide valuable perspective for defining and measuring success beyond simple service utilization counts [47, 54]. The plan intends to use data to drive outcomes and improve systems [55], and the insights from successful lived experiences are crucial for identifying what “better outcomes” truly mean for individuals facing homelessness. In summary, while the specific details of Duran’s path are not in the sources, his awareness of the lived experience of prolonged homelessness and ultimately achieving housing exemplifies the very challenges and desired outcomes the LAC-DMH Innovations Plan, particularly the models targeting the homeless population and utilizing peer support, seeks to address [2-4, 6, 9, 10, 12-19, 22, 42]. This awareness, viewed through the lens of his artistic and systemic frameworks (as discussed in the podcast and outline) which emphasize understanding processes, utilizing individual experiences, and facilitating “directional movement,” provides a vital, ground-level perspective on overcoming fragmentation, building effective support systems, and achieving meaningful recovery and housing stability [40, 41, 43, 44, 46]. ——————————————————————————– Qualitative Production and Artistic Community Collaboration Based on the “NOVATION MOTIVATION” outline, the author, presumably Ocean Duran as indicated by “Ographer Ocean Duran” [1, 2], sees a solution through what can be interpreted as “foreseeable relations” within the artistic and business community. While the exact term “foreseeable relations” is not used, the document emphasizes the importance of new personal network relations [3], the community of the arts network [4], community collaboration [5], and leveraging these relationships for growth and creating opportunities [6-8]. The author proposes a solution through a “Qualitative Production Model” called “Performers Paramount” and an outreach program called “Reaching for the Stars” [2, 9]. These models are designed to provide for performance and production, aiming for qualitative results [9]. The structure implies that each component involved, including relationships and collaborations, is a performer based on its ability to facilitate the production process [9]. The solution proposed by these “foreseeable relations” involves: • Streamlining the process of creating a production into a fully functional system [4]. This relies on outsourcing external influences, such as social class, culture, reference groups, and family and friends, to help create the system [4]. • Creating a networking resource of various creative outlets [8]. This allows for new relations and connections to be produced, leading to growth on both micro and macro levels [8]. • Utilizing the community so that needs are satisfied and met [8]. The success of an event relies on communication, quality talent, artistic appeal, and the ability for growth [6]. • Providing work and job opportunities for talent and industry professionals [2]. The “Reaching for the Stars” outreach program, built on the foundation of “Performers Paramount,” aims to achieve this by embracing a more incorporated idea and creating a streamlined workflow order [2]. This becomes a remedial component to what is lacking in the present recession, specifically directional movement [2]. • Overcoming challenges and addressing weaknesses by recognizing variables and formation [10, 11]. The structured components of “Performers Paramount” offer “qualitative resolve” [2]. • Implementing strategies to achieve outcomes and benefits [12]. Contributions from each performer and crew member contribute to the show so that growth occurs and a resourceful networking process creates opportunities [7]. In essence, the author sees the solution stemming from the ability to effectively organize information and implement strategies [1] by leveraging the inherent strengths and collaborative potential of the artistic community and its network [4, 6-8]. This network, or the “foreseeable relations,” provides the foundation and resources necessary to create a functional system that produces opportunities, fosters growth, and addresses challenges within the industry, offering a “beneficially life experience” [2]. ——————————————————————————– Mental Health Innovation, Art, and Community Process Here is a detailed briefing document reviewing the main themes and most important ideas or facts from the provided sources: Briefing Document: Mental Health Innovation and Artistic Expression as a Framework for Understanding Process and Value This briefing document synthesizes key information from excerpts of the Los Angeles County Department of Mental Health (LACDMH) Mental Health Services Act (MHSA) Innovation Plan (INN) from 2009 and two documents by Ographer Ocean Duran, “oceanREmixEDscreenplay3-2.pdf” and “outline NovationMotivationByOceanDuran.pdf”. While seemingly disparate, these sources offer insights into distinct yet potentially overlapping approaches to innovation, community engagement, addressing unmet needs, and the value of lived experience and creative processes. Source 1: LACDMH MHSA Innovation Plan (INN) Main Theme: Addressing fragmentation and increasing access to mental health, physical health, and substance abuse services, particularly for underserved and under-represented populations, through innovative, community-driven, and peer-supported models. Most Important Ideas/Facts: • Purpose of the MHSA Innovation Plan: The plan is explicitly focused on “learning rather than service provision,” aiming to “identif[y] new practices for the primary goal of learning and increasing the array of creative and effective approaches that can be applied to mental health services for specified populations.” The primary purpose, identified through stakeholder process, is to “Increase the Quality of Services, including Better Outcomes” by addressing “system fragmentation.” • Target Populations: The plan prioritizes three populations greatly impacted by decreased funding and fragmentation: ◦ The uninsured ◦ The homeless ◦ Underrepresented ethnic populations (UREP), specifically African/African American, American Indian/Native American, Asian and Pacific Islander, Eastern European/Middle Eastern, and Latino communities. • Critical Issues Identified: The plan highlights three critical issues requiring innovative strategies: ◦ “the fraying safety net of mental health, health and other social services for the uninsured, as a result of decreased funding and growth in the number of uninsured persons” ◦ “the fragmentation of mental health, health, and substance abuse services” ◦ “the decreased capacity to serve uninsured clients potentially displaced from services as a result of shrinking County General Funds.” • Key Innovation Models Proposed: The plan details several models designed to address these issues and serve the target populations: ◦ Community-Designed Integrated Service Management (ISM) Model: This model addresses fragmentation by “building on the strengths of a community, especially underserved ethnic communities.” It involves collaboration between formal providers and community-based organizations to integrate health, mental health, substance abuse, and other needed care. A core principle is to “provide effective mental health treatment to UREP communities, the public mental health system must adopt culturally competent and holistic strategies anchored in and supported by UREP communities that complement and enhance formal mental health services.” The model includes peer-based engagement, enhanced linkage and advocacy, and the intertwining of formal and non-traditional services. ◦ Integrated Peer-Run Model: This model utilizes peer support to address mental health, physical health, and substance abuse issues. It incorporates two strategies: Peer-Run Integrated Services Management (PRISM), a client-driven, holistic alternative for uninsured peers, and Alternative Peer-Run Crisis Houses, client-driven alternatives to hospitalization run by peers, including one dedicated to individuals released from jail. This model is innovative in combining these strategies and expanding possibilities for peer staffing, including administration and supervision. ◦ Integrated Mobile Health Team Model: This model utilizes multidisciplinary teams (physical health, mental health, substance abuse professionals, and specialized staff like housing/employment/benefit establishment specialists and peer/family/parent advocates) to provide services to homeless individuals, particularly those in permanent supportive housing (PSH). A unique feature is the use of “project-based service vouchers” tied to PSH units to leverage housing capital and ensure continued access to integrated services even if a client moves. Services are client-centered and based on identified needs (housing, physical health, mental health, or substance abuse). • Emphasis on Cultural Competence and Stakeholder Input: A cornerstone of the planning process was the empowerment of UREP groups to inform culturally and linguistically-competent approaches. The plan specifically mentions five distinct UREP subcommittees whose “collective wisdom” guided the development of the Community-Designed ISM Model. Stakeholder input was sought throughout the planning process and is integrated into the evaluation plan. • Projected Reach and Funding: The plan requests a total of $20,293,924 for FY 2009/2010 for the INN Plan. Specific funding amounts are allocated to the different UREP groups within the ISM model based on factors like poverty, prevalence, and penetration rates. The Community-Designed ISM Model aims to serve 1,400 families annually (2,800 individuals over two years of initial funding). The Integrated Peer-Run Model aims to serve 516 clients annually. The Integrated Mobile Health Team Model is estimated to serve 900 individuals and their families annually. • Learning Objectives and Evaluation: The plan is framed as a “learning grant.” Evaluation measures are outlined, including tracking client outcomes, assessing the effectiveness of non-traditional community-based providers, identifying and addressing barriers to implementation, and evaluating stakeholder satisfaction. The ISM model aims to learn about leveraging community resources and the actual cost of delivering integrated, culturally competent care. Source 2: “oceanREmixEDscreenplay3-2.pdf” and “outline NovationMotivationByOceanDuran.pdf” by Ographer Ocean Duran Main Theme: Exploring the relationship between art, life, personal experience, and the development of skills and wisdom through a process of self-discovery, environmental interaction, and production. Most Important Ideas/Facts: • Artistic Mission and Social Realism: The artistic mission is described as “Art imitating Life~2,” utilizing “the greatest philosophical resource that we have in our societies… our ability for stimulating our environment.” This leads to understanding relativity and forming correlating activities based on individual values. The concept of “Social realism” is introduced as the “use of realistic portrayals of life in art or literature to make a social or political point.” • Individual Resourcefulness and Environmental Interaction: The work emphasizes the individual becoming “self reliant by creating (for himself) a resourceful plan to EXECUTE PRODUCTION.” This resourcefulness is then applied to interacting with the environment, identifying contrasting elements within oneself and the environment, leading to a “design of discovery” and a “more accommodating reality.” • Methodology and Support Systems: The proposed methodology involves “Universal design or a structured formation in which, by process of elimination, will prove the designs absolution.” Support systems are built by developing skills that utilize one’s “talents and experiences to perform and provide educational material that supports the design.” • Communication and Process: The value of expression is perceived through the “communicative value of process.” Principles involved in this environment “find purpose in the process of communication by utilizing individualism and it’s coherent design of universal relativity.” • Production of Wisdom: The process of production, especially one that involves the community, is seen as generating wisdom. “WHAT IS GAINED THROUGH THESE STUDIES, PROVES TO BE MORE THAN A SKILL THAT IS PRACTICED because of the correlative design and provides a system (expressing) the wisdom that develops during the production.” Wisdom is seen when objectives are clear and components find their “correlative usage within the infrastructure that shows it’s environmental impact among the other components.” • Contrasting Elements and Distance vs. Hierarchy: Learning is facilitated by “showing them first the elements TO CONTRAST AND BRING FORTH DIFFERENCES by researching other methods of measurement which measure DISTANCE INSTEAD OF HIERARCHY, (thus showing) it’s structure of process.” • Rhythm and Pattern: Rhythm is described as most noticeable when individuals are “in ‘sync’ with either past experiences or by environmental impact.” Understanding rhythm is a “form of wisdom that one can easily understand when they experience a situation that they have been able to surpass by observation.” “Patterns” are identified as a “medium” or connecting component recognized because they conform to “our own personal methods to successfully achieve principals in which we conduct our lives.” • Business Models and Serving the Consumer: Business models are designed to “serve the consumer based on what has already been established.” This involves creating an initial product of interest and then developing “accessories” to reach a broader market. The goal of a product or purchase is movement; if it’s “still,” action is needed to involve the customer. • Human Capital and Innate Ability to Adapt: Personal directives identify strengths and weaknesses for procurement, focusing on “Human capital gain and increase” and the “Learning an innate ability to adapt in a situation by propositioning artistic methods as a practical” skill. • Critical Resource Functionality and Systematic Resourcing: The philosophy of the “biz” involves “Strategic Implements” (entertainment, funding, re-establishment of learning) and “Systematic Resourcing” which includes “Performance Production” and a “Resourcing process to help remedy a cause.” • Existence and Innovation: Existence is seen as living “based on the notion of how it relates in purpose to how it lives ‘now’ in its meaning or by how it comes to stand.” Systematic resourcing and performance production are a “basis on what surrounds the centralized focus of the current, greater formation produced naturally for remedial needs or innovation to the standard.” • Value of Community Production: A production involving its community creates a process that can “service the community so that it engages other sources, not usually associated to it.” This is achieved by adhering to the strengths of each identity within the community. • Proposed Services and Needs: The proposed services are described as a “specialized ability correlative to the educative up-bringing as an innovative and motivative Muse!” The needs and opportunity identified are “To bring forth core philosophical strategies and movement within that has acquired the applicable skills to “know how to move it on out”.” Overlap and Potential Connections: While the LACDMH document focuses on a large-scale public mental health system and the Duran documents explore a more personal, artistic, and philosophical approach, several potential areas of connection and overlap exist: • Innovation and Learning: Both sources emphasize innovation as a process of learning and exploration. The LACDMH plan is a “learning grant,” and Duran’s work is centered on developing skills and wisdom through experience and production. • Addressing Unmet Needs: The LACDMH plan explicitly addresses the unmet mental health needs of specific vulnerable populations. Duran’s work, through the concept of “Systematic Resourcing” and a “Resourcing process to help remedy a cause,” suggests a framework for addressing needs through creative production and community engagement. • Community Engagement and Collaboration: The LACDMH Community-Designed ISM model is heavily reliant on the “collective wisdom” and collaboration of UREP communities. Duran’s concept of a “production that involves its community” and engaging “other sources” aligns with this emphasis on community involvement. • Value of Lived Experience: The LACDMH Integrated Peer-Run Model is founded on the principle of utilizing individuals with “lived experience of mental health issues.” Duran’s work also emphasizes the value of individual experience, personal assessments, and developing skills through lived situations (“experience a situation that they have been able to surpass by observation”). • Holistic and Integrated Approaches: The LACDMH models aim for integrated care across mental health, physical health, and substance abuse, as well as connecting with non-traditional supports. Duran’s concept of “Art imitating Life” and the interconnectedness of elements within an environment suggest a holistic perspective on human experience and well-being. • Process and Design: Both sources highlight the importance of process and design. The LACDMH plan outlines specific models and implementation timelines, while Duran’s work explores “Program Planning Models,” “framework ‘design’,” and the “structure of process.” In conclusion, the LACDMH document provides a concrete example of a large public system attempting to innovate to address complex social and health issues through structured programs and community collaboration. The Duran documents offer a more abstract and philosophical exploration of personal innovation, the role of art, and the process of creating value and wisdom through self-reliance, environmental interaction, and collaborative production. Juxtaposing these sources reveals potential intersections in their shared emphasis on the value of experience, community, process, and the pursuit of positive outcomes, whether those outcomes are improved mental health access or the development of personal and collective wisdom. ——————————————————————————– LA Mental Health Innovation Plan: Timeline and People Here is a detailed timeline and cast of characters based on the provided sources: Timeline of Events • Early May 2009: The extensive and intensive planning process for the Los Angeles County Department of Mental Health (LAC-DMH) Mental Health Services Act (MHSA) Innovation (INN) Plan begins. • February 18, 2009: The Los Angeles County MHSA Stakeholder Delegates endorse a process that focuses the Innovations Plan on three critical questions: the fraying safety net for the uninsured, fragmentation of services, and decreased capacity to serve uninsured clients due to shrinking County General Funds. They also prioritize specific populations: the uninsured, homeless, and Underrepresented Ethnic Populations (UREP). • May 19, 2009: Funding for Innovations planning is assured following an election, allowing the planning process to pick up in earnest. • June 24, 2009: The MHSA Stakeholder Delegates approve a planning structure for the Innovations Plan, including broad public input, work groups focused on target populations, and the inclusion of consumers, family members, parents, and caregivers in formal decision-making roles. • September 25, 2009: The MHSA-Innovations (INN) Strategies Submission Log is compiled, listing various proposed strategies from different submitters and identifying which target populations (Homeless, Uninsured, UREP) they address. This log includes a diverse range of initiatives from various organizations and individuals. • October 20 – November 19, 2009: A 30-day public comment period for the LAC-DMH MHSA Innovation Plan is completed. • November 19, 2009: A Public Hearing for the LAC-DMH MHSA Innovation Plan is hosted by the Los Angeles County Mental Health Commission. Comments and questions are received and audio recorded, with a typed transcriber for accuracy. • November 24, 2009: Projected Revenues and Expenditures for Work Plan #1 (Integrated Clinics Model), Work Plan #2 (Integrated Mobile Health Team Model), and Work Plan #4 (Peer-Run Model) are prepared by Ansara J. Lewis. • November 25, 2009: The Innovation Work Plan Narrative for the Integrated Peer-Run Model (Work Plan #4) and the Community-Designed Integrated Service Management Model are dated. • December 1, 2009: The County of Los Angeles Department of Mental Health formally submits a request to amend its MHSA Agreement to include an increased level of funding for Fiscal Year 2009-2010. The submission includes the LAC-DMH MHSA Innovation Plan and requests $20,293,924 for FY 2009/2010. • January 2010 (Estimated): Estimated Plan Approval from the California Department of Mental Health. • February – April 2010: Competitive Bidding Process for the Innovations Plan projects is scheduled to take place. • May – July 2010: Contract Negotiations, Board Approval, and Awarding of Contracts for the Innovations Plan projects are scheduled to take place. • August – October 2010: Start up and Staffing of ISM Teams (Community-Designed Integrated Service Management Model) and Peer-Run Models are scheduled to begin. This includes training of culturally diverse staff for the Peer-Run Models. Monitoring and review of participating community-based partner providers for the ISM Teams will also begin. • November 1, 2010: The 1st Quarterly Formative Evaluation and Reporting for the ISM Model is scheduled. This involves identifying, monitoring, and addressing barriers to implementation. • November 2010 – January 2011: Outreach, Engagement, Linkage, Education, and Training activities for the ISM Model are scheduled. Evaluation of essential components for successful culturally-informed peer-based facilitation will also occur. • February – May 2011: ISM Services are scheduled to be Provided to Families. • June 1, 2011: The 3rd Quarterly Formative Evaluation and Reporting for the ISM Model is scheduled. This includes measuring service completion rates, evaluating non-traditional providers, assessing barrier reduction, and determining if community needs are being met. • June 2011 – August 2012: ISM Services continue to be Provided to Families. Information on the number of non-traditional community-based partners providing services will be gathered. • September – December 2012: Summative Evaluation/Final Report for the ISM Model is scheduled. Results and learnings will be shared with various audiences. • Unknown Date (post-2012): Ocean Duran creates “MasterPiece N’Mocean” (by Ographer Ocean Duran), a screenplay or artistic work that incorporates themes of artistic mission, social realism, resourcefulness, personal purpose, methodology, support systems, implications of skill development, universal design, and wisdom gained through production. • Unknown Date (post-2012): Ocean Duran creates the “outline NovationMotivationByOceanDuran.pdf,” which details his artistic mission, program planning model (NovationMotivation), impact assessment, scientific and design methods, timeline concepts related to movement and consumer engagement, personal directives, critical resource functionality (including performance production and remedying a cause), and systematic implements for program development. Cast of Characters • Marvin J. Southard, D.S.W.: Director of the County of Los Angeles Department of Mental Health (LAC-DMH). • Roderick Shaner, M.D.: Medical Director of the County of Los Angeles Department of Mental Health (LAC-DMH). • Robin Kay, Ph.D.: Chief Deputy Director of the County of Los Angeles Department of Mental Health (LAC-DMH). • Gladys Lee, LCSW: District Chief of the LAC-DMH Planning Division. She is the point of contact for questions, comments, and revisions requests regarding the MHSA Innovation Plan submission. • Los Angeles County MHSA Stakeholder Delegates: A countywide, diverse, and representative group specifically created to ensure wide and meaningful public participation in ongoing MHSA planning. They were instrumental in endorsing and approving the planning process and structure for the Innovations Plan. • Jerry Lubin: Chair of the Los Angeles County Mental Health Commission who chaired the Public Hearing on the Innovations Plan. • Rigo Rodriguez: Facilitator of the Public Hearing on the Los Angeles County Department of Mental Health Innovations Plan. • Ansara J. Lewis: Prepared the Innovation Projected Revenues and Expenditures for several Work Plans in the LAC-DMH MHSA Innovation Plan. • Ocean Duran: Artist, Ographer, and creator of the screenplay “MasterPiece N’Mocean” and the outline “NovationMotivationByOceanDuran.pdf”. His work explores themes of artistic mission, social realism, innovation, motivation, and systematic approaches to production and personal development. He is also associated with “oceanremix@yahoo.com” and “oceanduran copyright2012”. • Peggy Edwards: Submitter of two strategies listed in the MHSA-Innovations (INN) Strategies Submission Log: “ACE Study-Based System of Primary Medical Care, Supportive Services, and Health Education” and “Vulnerable Veterans Initiative”. • AFSCME: Submitter of two strategies listed in the MHSA-Innovations (INN) Strategies Submission Log: “Advocacy to Increase Ease/Flexibility of attempting employment for persons with disabilities” and “Seeking substance abuse treatment for individuals receiving Section 8 housing”. • James Randall: Associated with DMH and submitted strategies including “Consumer and Family” and “Recovery After Initial Schizophrenia Episode (RAISE) Program”. • Stars, Inc: Submitter of the strategy “Core Gift Coorporation with Sol Adventurers Foundation”. • Black Los Angeles County Client Coalition (BLACCC): Submitter of the strategy “Cross-Sector Collaborative Project”. • Inner City Industry (ICI): Submitter of the strategy “Dedication to Education Street Team Mentor Program”. • Heritage Clinic: Submitter of the strategy “Developing an Evidenced Based Practice for Ethnic Psychotic Elders”. • DPSS: Submitter of the strategy “DPSS/DMH Collaboration to Transition GR NSAs to SSI”. • CONNECTING – it works! Inc: Submitter of the strategy “Dr Floyd McGregor’s Chill Out CBT Anger Management Program”. • Tarzana Treatment Centers: Submitter of strategies including “Integrated Care for Consumers with Co-Occurring Disorders”, “Medication-Assisted Therapy with Vivitrol for Alcohol Dependent, Trauma-Exposed COD Individuals”, and “School Based Mental Health and Substance Abuse Prevention”. • Don Parrington: Submitter of the strategy “Integrated Dual Disorder Treatment Quality and Access Improvement”. • SF Valley Community Mental Health Center: Submitter of the strategy “Integrated Healthcare, Mental Health, SA Services to Homeless Mentally Ill”. • Didi Hirsch Mental Health Services: Submitter of strategies including “Integrated Primary and Behavioral Healthcare for Mental Health Consumers” and “Trauma Informed Afterschool Program for Middle School Students”. • Mandy Johnson: Submitter of the strategy “Integrated School Health Center”. • Mollie Lowery: Submitter of strategies including “Integrated Supportive Housing Management” and “Project to Access and Sustain Permanent Housing (PAS)”. • Community Clinic Association of LA: Submitter of the strategy “Integrating Behavioral Health into the Medical Home”. • LA Gay & Lesbian Center: Submitter of strategies including “Life Works LA” and “Stop LGBTQ Family Violence”. • Long Beach TAY Collaborative: Submitter of the strategy “Long Beach TAY Collaborative”. • Step up on Second: Submitter of strategies including “Low Barrier Drop In Center for Homeless TAY” and “Volunteer Companions”. • Community Family Guidance Center: Submitter of the strategy “Marketing Fiscal Sources for DMH programs to School Officials”. • Mary Lind Recovery Centers: Submitter of the strategy “Mary Lind COD Integration Strategy”. • DMH-Older Adult Programs Admin: Submitter of strategies including “Older Adult UREP Peer Support Project” and “Primary Care-Based Telepsychiatry”. • Latino UREP: Submitter of the strategy “Ourtreach, Linkage and Education-OLE”. • Para Los Ninos: Submitter of the strategy “Para Los Ninos Mental Health Collaborative Care Model”. • Child Care Resource Center (CCRC): Submitter of the strategy “Parents and Child Care Providers Working Together for the Future”. • Project Return: Submitter of the strategy “Peer-Run Respite House Project”. • Kedren Community Health Center: Submitter of the strategy “Pilot Integrating Health, Mental Health and Supportive Services to Head Start Families”. • Skid Row Housing Trust: Submitter of the strategy “Project-Based Service Vouchers (PBSV)”. • California Healthy Marriages Coalition: Submitter of the strategy “Promoting Mental Health through Healthy Relationship Skills”. • Prototypes: Submitter of the strategy “PROTOTYPES Center for Innovation and Integration”. • Armenian Relief Society of West USA: Submitter of the strategy “Reach Out to At-Risk, Trauma Exposed Families”. • Diane McNeal: Submitter of the strategy “Regenerative Transitional Behavior Therapy (RTBT-T)”. • EE/ME UREP: Submitter of the strategy “Outreach and Referral Center for Multicultural Mental Health Services”. • Children’s Institute: Submitter of strategies including “Responding to Domestic Violence: The “Whole Person” Approach”, “Trauma Systems Therapy for Substance Abusing Adolescents and Transitional Age Youth”, and “Wellness on Wheels”. • LA Child Guidance Clinic: Submitter of strategies including “Salud Y Familia Media Campaign” and “The Three R’s – Building Relationships, Resiliency & Recovery”. • Vista Del Mar Child and Family Services: Submitter of the strategy “Secure Attachment for Family Engagement (SAFE)”. • Special Service for Groups: Submitter of the strategy “SPA 6 Restoration Center (S6RC)”. • Laurel Bear, Rosalie Finer-Alliant Int.: Submitters of the strategy “Steps to Success”. • Family Service: Submitter of the strategy “Strength Through Access and Resources (STAR)”. • LBHI: Submitter of the strategy “System Development: Mental Health, Substance Abuse, and Health Program”. • Antelope Valley Partners for Health: Submitter of the strategy “Teachers and Life Coaches (TLC)”. • AI UREP: Submitter of the strategy “The Restoring Urban Traditional Healing (RUTH) Project”. • SCHARP: Submitter of the strategy “The SHARE Program”. • Therese Haviland: Submitter of the strategy “Therese Haviland’s CBT Langauge Arts Therapy”. • Children’s Hospital: Submitter of the strategy “Understanding and Addressing Homelessness in the Context of Trauma”. • Choices Recovery Services: Submitter of strategies including “Video Conference Technology Field based Psychiatric Services” and “Youth Outreach Trailer to deliver PEI Mental Health Services”. • Kathy Millet: Submitter of the strategy “Advancing the Transition to Adulthood Among Older Youth and Young Adults with MH Needs and Fragile Community Connectedness (Advancing Pathways to Success)”. • DMH – EAD: Submitter of several strategies including “Hire Staff to Assist Under-Age (less than 60) Hoarders”, “Peer-Run Crisis Residential Program”, “Procovery”, “Peer Support Strategies For Consumers”, and “Collaborative Care Strategy for Consumers”. • Ruth Hollman: Submitter of the strategy “Provide Support for People with Mental Health Problems”. • Consumers, Families, Parents, and Caregivers: Integral participants in the planning process of the MHSA Innovations Plan, providing input and holding formal decision-making roles. They are also the primary recipients of the services proposed in the plan. • Underrepresented Ethnic Populations (UREP) Subcommittees: Five distinct subcommittees representing African Immigrant/African American (A/AA), American Indian (AI), Asian Pacific Islander (API), Eastern European/Middle Eastern (EE/ME), and Latino communities. They provided crucial input and wisdom for the development of culturally competent approaches in the Innovations Plan, particularly the Community-Designed Integrated Service Management Model. • Community-Based Partner Providers: Organizations and providers that will potentially contract with LAC-DMH to implement the Innovations Plan projects, particularly the Integrated Service Management (ISM) and Peer-Run Models. • Non-traditional Community-Based Providers: Partners who will provide services within the ISM model, likely rooted in specific ethnic communities and drawing upon cultural norms and resources. • Integrated Mobile Health Team: A multidisciplinary team proposed in one of the Innovations Plan models, including physical health, mental health, and substance abuse professionals and specialized staff. They would provide integrated services to homeless individuals. • Peer Specialists (“bridgers”, advocates, supporters): Individuals with lived experience of mental health issues who will primarily support their peers in the Integrated Peer-Run Model. • Family Specialists: Individuals whose family members have had mental health issues, functioning as support for families in crisis within the Peer-Run Model. • Parent Partners: Parents/caregivers with children who have had mental health issues, functioning as support for other parents/caregivers in crisis with children who have mental health issues within the Peer-Run Model. • The “Spirit of God”: A character mentioned in the excerpt from Genesis 1, described as hovering over the waters in the beginning. • God: The creator figure described in the excerpt from Genesis 1, responsible for the creation of the heavens and the earth, light, sky, land, seas, vegetation, lights in the sky, living creatures in the water and sky, livestock, creatures on the ground, wild animals, and mankind. ——————————————————————————– Mental Health Innovation and Human Capital Development Innovations in Mental Health and Artistic Expression Quiz 1. What is the primary purpose of the MHSA Innovations (INN) Plan in Los Angeles County, as stated in the document? 2. What are the three critical issues the LAC-DMH MHSA Stakeholder Delegates prioritized for attention through innovative strategies? 3. Name three of the five Under-Represented Ethnic Populations (UREP) subcommittees identified in the LAC-DMH plan. 4. Describe the core concept of the Integrated Service Management (ISM) Team within the Community-Designed ISM Model. 5. What are Peer-Run Crisis Houses designed to provide as an alternative to hospitalization? 6. How does the Community-Designed ISM Model propose to address disparities in access to mental health services for UREP communities? 7. According to the “oceanREmixEDscreenplay3-2.pdf,” what is considered the “greatest philosophical resource that we have in our societies”? 8. In the context of the “outline NovationMotivationByOceanDuran.pdf,” what is the significance of finding contrasting elements within an individual and utilizing their environment? 9. What does the “outline NovationMotivationByOceanDuran.pdf” suggest is gained through the studies and production process described? 10. Based on the “outline NovationMotivationByOceanDuran.pdf,” what does “Human capital gain and increase” represent within the framework of personal directives? Answer Key 1. The primary purpose of the MHSA Innovations (INN) Plan is learning, focusing on identifying new practices to increase the array of creative and effective approaches for mental health services. 2. The three critical issues are the fraying safety net for the uninsured, fragmentation of services (mental health, health, substance abuse), and decreased capacity to serve uninsured clients due to shrinking County General Funds. 3. African/African-American, American Indian, Asian/Pacific Islander, Eastern European/Middle Eastern, and Latino. (Any three of these are acceptable). 4. The ISM Team is a multidisciplinary health team that works under one agency or supervision to provide integrated health, mental health, and substance abuse services with client-centered goals. 5. Peer-Run Crisis Houses are designed to provide a warm, safe, welcoming environment for uninsured people in psychiatric distress who are not a danger to others, serving as alternatives to hospitalization. 6. The Community-Designed ISM Model seeks to bridge the gap between ethnic communities and formal care providers by allowing communities to direct how services are integrated into trusted institutions and utilizing community-specific peer-based outreach. 7. The “greatest philosophical resource” is our ability for stimulating our environment, which leads to foundations of relativity and the formation of correlating activities. 8. Finding contrasting elements and utilizing the environment is part of the relation process, which develops a design of discovery that allows an individual to see beyond social obstacles and understand a more accommodating reality. 9. Through these studies and production, more than just a practiced skill is gained; it provides a system for expressing the wisdom that develops during the production process, where objectives become clear through correlative usage. 10. “Human capital gain and increase” represents the strengthening and expansion of an individual’s abilities, knowledge, and skills as a result of the processes and learning described, contributing to their overall worth and capacity. Essay Format Questions 1. Analyze the different innovative models proposed in the LAC-DMH MHSA Innovation Plan. Discuss how each model attempts to address the identified critical issues and serve the target populations, highlighting their unique features and potential benefits. 2. Evaluate the role of stakeholder input, particularly from Under-Represented Ethnic Populations (UREP) communities, in the development and implementation of the Community-Designed Integrated Service Management (ISM) Model. How does this input shape the model’s principles and intended outcomes? 3. Compare and contrast the Integrated Peer-Run Model and the Community-Designed Integrated Service Management Model. Discuss their similarities in goals and differences in approach, particularly concerning the roles of peers and community involvement. 4. Explore the concept of “systematic resourcing” as presented in the “outline NovationMotivationByOceanDuran.pdf.” How does this concept relate to problem-solving and innovation within the context of the provided texts, and what are its implications for achieving desired outcomes? 5. Discuss the intersection of artistic mission, personal development, and community engagement as presented across the provided sources. How do the ideas of self-reliance, environmental stimulation, and the utilization of individual talents contribute to both personal and societal progress? Glossary of Key Terms • Community-Designed ISM Model: An innovative model in the LAC-DMH plan that builds on community strengths, especially in underserved ethnic communities, to integrate health, mental health, substance abuse, and other needed care through collaboration between regulated entities, contract providers, and community-based organizations. • Correlative Practices/Correlative Design: Methods or structures that allow for the measurement of personal success or demonstrate a system of wisdom development by relating different elements or aspects. • Harm Reduction: Strategies designed to reduce the risk of harm associated with certain behaviors, such as drug abuse. • Holistic Support: A comprehensive approach to assisting clients that addresses not only their health, mental health, and substance abuse needs but also other services like transportation, follow-up, encouragement, and communication, often in a culturally and linguistically competent manner. • Human Capital: The skills, knowledge, and experience possessed by an individual or population, viewed in terms of their value or cost to an organization or country. In the context of the source material, it relates to gaining and increasing these attributes. • Integrated Mobile Health Team: A multidisciplinary health team (including mental health, physical health, and substance abuse professionals, as well as specialized staff like housing/employment specialists and peer/family advocates) that provides services to homeless individuals and those in Permanent Supportive Housing (PSH). • Integrated Peer-Run Model: An innovative model utilizing peer support to identify, obtain, and coordinate mental health, physical health, and substance abuse care for uninsured individuals, reducing system fragmentation. It includes strategies like Peer Run Integrated Services Management (PRISM) and Peer-Run Crisis Houses. • Innovation (INN) Plan (MHSA): The final plan component of the Mental Health Services Act in LA County, focused on learning and identifying new practices to increase creative and effective approaches for mental health services. • Mental Health Services Act (MHSA): California legislation that provides funding for expanded county mental health services. The Innovations (INN) Plan is a component of MHSA. • Peer Advocates/Peer Specialists: Individuals with lived experience of mental health issues who provide support, information, motivation, and encouragement to their peers, often assisting with service access and communication. • Peer-Run Crisis Houses: Client-driven, holistic alternatives to hospitalization designed to provide a safe and welcoming environment for uninsured individuals experiencing psychiatric distress who are not a danger to others. • Peer Run Integrated Services Management (PRISM): A client-driven, holistic alternative within the Integrated Peer-Run Model that allows uninsured peers to secure needed physical health, mental health, and substance abuse options as part of a program designed and run by people with lived experience. • Permanent Supportive Housing (PSH): Housing units dedicated to serving the MHSA focal population, often with project-based service vouchers that provide access to integrated support services. • Provisionary Management: A concept described as involving Lingo, Location, and Lending, suggesting a preparatory or qualifying approach to management. • Project-Based Service Vouchers (PBSV): Vouchers committed to housing developers interested in building PSH units, used to leverage housing capital and indicate developer access to integrated services provided by an Integrated Mobile Health Team. • Recidivism: The tendency of a convicted criminal to reoffend. In the context of mental health services, it might refer to individuals dropping out of services or experiencing recurring crises. • Rhythm Patterns N’Mocean (RPM): A concept related to situational events recalling chronological events that direct movement (“M’ocean”) for evidential outcomes, often recognized through patterns that conform to personal methods and principals. • Social Realism: The use of realistic portrayals of life in art or literature to make a social or political point. • Speech Acts Theory: A linguistic theory that analyzes how utterances are used to perform actions, often combined with probability theory to assess behavior. • Stakeholder Delegates (MHSA): A countywide, diverse, and representative group specifically created to ensure wide and meaningful public participation in ongoing MHSA planning in Los Angeles County. • Systematic Implements: Defined as systematic observations of formational elements for progression in the learning curve, applying elemental structure according to artistic plans, and formulating business definitions. • Systematic Resourcing: A basis for understanding what surrounds a centralized focus for remedial needs or innovation, involving performance production and a resourcing process to help remedy a cause. • Under-Represented Ethnic Populations (UREP): Communities that have been historically on the periphery of the mental health system, identified in Los Angeles County as African Immigrant/African American, American Indian, Asian Pacific Islander, Eastern European/Middle Eastern, and Latino. • Universal Design: A structured formation or processing method that, by process of elimination, aims to prove the absolution of designs. • Vulnerability Index (Common Ground): A method used to assess the vulnerability of homeless individuals, often determining those most likely to die within the next year based on disabling conditions. ——————————————————————————– Purpose of the Integrated Clinic Model Based on the sources provided, the purpose of the Integrated Clinic Model within the LAC-DMH Innovations Plan is multifaceted, aligning with the overall goals of the plan [1, 2]. The primary purpose for the entire Innovations Plan, selected through a stakeholder process, is to Increase the Quality of Services, including Better Outcomes [1-5]. The stakeholders determined that successfully healing system fragmentation is a major impediment to service quality and good outcomes, making this the highest priority [1-5]. The Integrated Clinic Model specifically addresses this by seeking to increase the quality of care and services for its target populations by reducing the fragmentation inherent in the current system of care [2, 6-8]. It aims to achieve this by combining physical health, mental health, and substance abuse services in community-based sites, such as primary care or mental health clinics [6, 7, 9-11]. This is intended to more fully address the spectrum of needs of individuals who are homeless, uninsured, and/or members of under-represented ethnic populations (UREP) [9-11]. Key aspects of the Integrated Clinic Model’s purpose derived from the sources include: • To increase access to mental health, physical health, and substance abuse services for those for whom services are fragmented and resources limited [9-11]. The “no wrong door” approach is used, meaning clients can access the full suite of services by engaging a provider in any of the three disciplines at a single site [12, 13]. • To increase the quality of services, including achieving better physical health and mental health outcomes, by having providers work together to coordinate care across practices [9, 10]. This involves using a multidisciplinary team approach to address the client as a whole, avoiding silos, duplication, and fragmentation [6, 14]. Potential increased quality of care and service and improved clinical outcomes are seen as inherent in an integrated care model [8]. • To provide a “home” for people seeking integrated care [2, 6, 7]. • To support the capacity of primary care or mental health clinics to integrate on-site mental health, physical health, and substance abuse treatment services in an effective, culturally-relevant, and consumer-driven manner [2, 6, 7]. This includes ensuring culturally and linguistically competent care [6, 15-18]. • To improve access and eliminate the stigma often experienced while seeking care at mental health-only sites by integrating services at primary care sites [8, 19, 20]. Integrating physical health services into mental health settings is also intended to increase access for clients with serious mental illness into physical health care [19, 20]. • To create an efficient and cost-effective system by utilizing existing infrastructure and leveraging other programs [9, 10]. Care coordination aims to facilitate access for high-risk populations, promote coordination across organizations and providers, ensure care at the appropriate level, and contain costs [21]. The goal is to deliver services in a cost-effective way [22, 23]. • To promote interagency collaboration between Los Angeles County departments and providers [9, 10]. • To focus on wellness in all disciplines [15, 18, 20]. • To reduce disparities in access to mental health and physical health services [19]. • To use data to drive outcomes, improve systems, and achieve client-centered results [18, 24, 25]. This includes using disease management software for quality improvement [26, 27] and tracking outcomes using a standardized electronic integrated care plan [26, 28]. In essence, the Integrated Clinic Model is designed to test if integrating mental health, physical health, and substance abuse services at community sites can effectively overcome system fragmentation, improve the quality and accessibility of care, lead to better outcomes for vulnerable populations, and do so efficiently and cost-effectively [2, 6-11, 23]. ——————————————————————————– Innovative Mental Healthcare for Underserved Populations Based on the sources, the Los Angeles County Department of Mental Health (LAC-DMH) Innovations Plan specifically focuses on addressing the needs of underserved groups [1-5]. The plan identifies three critical populations requiring attention through innovative strategies: the uninsured, homeless, and underrepresented ethnic populations (UREP) [6]. Under-Represented Ethnic Populations (UREP) are a key focus and include specific communities such as African/African American, American Indian/Native American, Asian and Pacific Islander, Eastern European/Middle Eastern, and Latino communities [6, 7]. The plan also acknowledges other sub-populations as underserved, such as linguistically-isolated families/individuals [8-10], families/individuals who have not accessed services due to stigma [8-10], families/individuals who have not benefitted from or received inappropriate services [8-10], and uninsured individuals from GLBTQI, Deaf or Hard-of-Hearing, and Blind or Visually Impaired communities [11-13]. Families, parents, and caregivers are also included in the stakeholder groups and target populations [1, 2, 5, 6, 14-17]. Key Issues Faced by Underserved Populations: The sources highlight that current care is fragmented, ineffective, and does not fully meet the needs of communities, particularly for those with minimal resources and high mental health needs [15]. Specific issues and barriers identified include: • Fragmentation of mental health, health, and substance abuse services [1, 3-6, 14, 15, 18-23]. • A fraying safety net due to decreased funding and growth in the number of uninsured persons [6]. • Decreased capacity to serve uninsured clients potentially displaced from services as a result of shrinking County General Funds [6]. • Stigma surrounding mental illness, which is a powerful barrier to seeking treatment [8, 10, 24-27]. Integrating mental health services into primary care settings can help reduce this stigma [24, 25, 28]. • Mistrust and fear of treatment, racism, discrimination, and differences in language and communication, particularly for UREP members [24]. • Lack of access to culturally-appropriate services, services not provided countywide in their language or within a comfortable cultural context, and formal providers not recognizing or knowing how to tap into inherent ethnic community resources [7, 9, 10, 29]. • Geographic boundaries for service delivery that are incongruent with ethnic communities [7]. • For homeless individuals, challenges include a lack of access to healthcare, dental care, mental health care, and drug/alcohol treatment, compounded by the adverse conditions of living on the streets [23]. How the Innovations Plan Addresses the Needs of Underserved Populations: The overarching goal of the plan is to ensure the availability of services to children, youth, adults, and older adults most challenged by severe and persistent mental illness, and to promote recovery [30]. Increasing access to underserved groups is one of the stated purposes of the proposed innovation projects [1-5]. The plan was designed through an extensive community participation process that included stakeholders from diverse groups, such as the MHSA UREP subcommittees and the Homeless Advisory Council [6, 18]. The plan proposes four integration models to address the critical question of what are the most effective models for integrating mental health, physical health, and substance abuse services for the uninsured, homeless, and UREP [14, 31, 32]. These models were specifically designed to be culturally competent and driven by consumers, family members, parents, and caregivers [1-5, 15]. 1. Integrated Clinic Model: This model targets the uninsured, homeless, and UREP by combining mental health, physical health, and substance abuse services in community-based sites like primary care or mental health clinics [2, 15, 19, 21, 24, 33, 34]. This approach aims to increase access by bringing services to locations people already frequent [19, 24, 25, 35] and uses a “no wrong door” approach [24]. It also seeks to increase the quality of services and outcomes [19, 21, 25, 35, 36]. The model’s innovation includes targeting the most vulnerable populations to test if integrated care improves service quality for them [37, 38]. Peers are included as staff [36-40]. 2. Integrated Mobile Health Team Model: Primarily designed for individuals with mental illness who are homeless, including those moving into permanent supportive housing (PSH), many of whom are uninsured and UREP [3, 20, 21, 41-43]. This model addresses the fragmentation of services for the homeless population [20, 35]. It uses a client-centered, housing-first approach with harm reduction strategies [20, 35, 44]. A mobile, integrated, multi-disciplinary team provides outreach and services where clients are located (streets, shelters, PSH) [20, 35]. It offers multiple points of entry based on the client’s identified need (housing, physical health, mental health, or substance abuse) [35, 41, 43]. Innovative funding mechanisms are used, such as project-based service vouchers tied to PSH units, to leverage housing capital and provide ongoing services regardless of residence [35, 41, 45]. 3. Community-Designed Integrated Service Management (ISM) Model: Explicitly focuses on Under-Represented Ethnic Populations (UREP) [4, 7, 9, 10, 21, 22, 33, 35, 46-48]. It addresses fragmentation by building on the strengths of ethnic communities [4, 22, 47] and envisions care defined by the community itself [4, 22, 35, 47]. The model promotes collaboration between formal and non-traditional providers (like faith-based organizations or community healers) and community organizations [4, 22, 35, 46, 47, 49, 50]. It uses culturally competent “service integrators,” including professionals and specially-trained peers, grounded in ethnic communities and their natural support systems [7, 22, 35, 46]. The model differentiates specific needs and approaches for the five distinct UREP communities [7, 22, 46, 48, 51] and utilizes community-designed peer-based outreach, engagement, linkage, education, and advocacy [22, 26, 27, 29, 46, 52-54] to address barriers like stigma and linguistic isolation [7, 8, 10]. Points of entry are through various community sites [8, 12, 22, 55]. Family members are a major focus in this model [8, 10]. 4. Integrated Peer-Run Model: This model supports uninsured adults with mental health needs, including those experiencing a crisis and those who may also be homeless and/or UREP [11, 16, 17, 33, 56]. It provides programs designed and run by people with lived experience of mental health issues (peers) [16, 17, 33]. The model incorporates Peer-Run Integrated Services Management (PRISM) and Alternative Peer-Run Crisis Houses as alternatives to traditional services or hospitalization [16, 17, 33]. PRISM utilizes peer teams to help uninsured peers secure and coordinate physical health, mental health, and substance abuse options based on a “whatever it takes” philosophy [16, 17, 33]. Both strategies are designed to be culturally competent, with support from peers similar linguistically and ethnically [16, 57]. The model aims to reduce fragmentation through a peer-driven approach [5, 17] and expands peer-run options within the public mental health system [16, 17, 33], including peer staffing, administration, and supervision [5, 16]. The plan’s selection of “Increase the Quality of Services, including Better Outcomes” as the primary purpose was determined through a stakeholder process that identified healing system fragmentation, which disproportionately affects underserved groups, as the highest priority [1-5]. LAC-DMH is committed to working alongside ethnic and cultural communities historically on the periphery of the mental health system [9, 48]. ——————————————————————————– Los Angeles County Mental Health Service Challenges Based on the sources, Los Angeles County faces several significant challenges in integrating mental health services with physical health and substance abuse services. A key overarching challenge is the fragmentation of the existing service system [1-13]. This fragmentation is seen as a major impediment to service quality and good outcomes [3], resulting in incomplete or inappropriate treatment for consumers [4]. Specific challenges contributing to this fragmentation and hindering integration include: • Services being located in different settings [5, 14, 15]. • Providers from various agencies working under separate systems, supervisors, regulations, and requirements [6-8]. Previous multi-disciplinary teams were hampered by accountability to different agencies and/or supervisors [7]. • Separate charts and care plans for clients [6, 7]. • Disparate and separate funding streams [6-8, 16-18]. Identifying mechanisms for sustainable funding for integrated programs is a goal and challenge [19-22]. • Limited capacity for communication, coordination, and sharing of information among programs and providers [14, 23]. • Intra-agency disagreements regarding target populations [16]. • Limited referral mechanisms and expertise among providers across different disciplines [16]. Improving provider competency around appropriate referrals is a learning question [24]. • Poorly defined outcome measures [16]. • The complexity of integrating care in a large, complex urban environment that includes both directly operated and contracted entities, especially given its geographic widespread nature [7, 9, 11, 12, 18, 25-30]. The proposed system changes are challenging, and the extent of fragmentation and barriers will not be fully understood until attempted [31]. • Difficulties utilizing existing community resources beyond a specific integrated system [16]. Furthermore, challenges are specific to populations and approaches: • Significant barriers to accessing services for target populations like the uninsured, homeless, and underrepresented ethnic populations (UREP) [32]. These barriers include stigma surrounding mental illness, distinct from issues of cost, fragmentation, and service availability [32]. • Additional barriers deterring members of UREP communities such as mistrust and fear of treatment, racism and discrimination, and differences in language and communication [32]. Challenges exist in providing services countywide in the language and cultural context preferred by these communities [33]. Formal providers have not always recognized or known how to tap into the inherent resources of ethnic communities [33]. • Difficulties in identifying, credentialing, and incorporating non-traditional practitioners into the formal mental health system, as well as developing mechanisms for them to bill for services [34-36]. • Resistance on the part of some people to referring consumers to consumer-run (peer-run) programs [37]. • A lack of alternatives to institutional and costly options like hospitals and Urgent Care Centers for people experiencing a mental health crisis [13]. • Funding gaps exist among existing public service systems that must be addressed to assure high-quality care for homeless mentally ill clients [22]. For example, while financial resources exist for permanent supportive housing development and operating subsidies, there is no dedicated funding source for supportive services [38]. Gaps also exist in allowable Federal Qualified Health Center (FQHC) service funding for fully integrated mobile health services [39]. The County is seeking to address these challenges through the MHSA Innovations Plan, which aims to learn how to best integrate services for vulnerable populations and heal system fragmentation [3, 4, 40]. The plan tests different models to determine effective approaches, including overcoming barriers and reducing fragmentation [18, 31]. ——————————————————————————– Integrating Los Angeles Mental Health Services Based on the sources, Los Angeles County Department of Mental Health (LAC-DMH) is the largest mental health service system in the nation, serving approximately one-quarter of a million residents each year [1]. The department provides a diverse spectrum of mental health services, including assessments, crisis intervention, case management, and medication support in both residential and outpatient settings [1]. Their workforce includes various professionals such as psychiatrists, psychologists, social workers, and mental health consumers [1]. The overarching goal of LAC-DMH’s plans is to ensure the availability of services to children, youth, adults, and older adults most challenged by severe and persistent mental illness and to promote recovery [2]. Key concepts guiding their service delivery include the achievement of positive outcomes, delivery of services in culturally appropriate ways, and addressing disparities in access, particularly for ethnic, cultural, and underserved communities [3]. A primary issue identified in the sources regarding mental health services in Los Angeles County is fragmentation [4, 5]. Mental health, physical health, and substance abuse services are often located in different settings, provided by different agencies under separate systems, supervisors, and regulations [6-8]. This insufficient integration results in incomplete or inappropriate treatment for consumers [4]. The failure to coordinate primary and behavioral health care has led to grave consequences for individuals with serious mental illnesses, including chronic medical conditions and early mortality [9]. A significant number of people in primary care settings also need behavioral health services, yet many who suffer from diagnosable mental disorders do not seek mental health care, or receive it solely from their general physician [9, 10]. The LAC-DMH MHSA Innovations Plan is specifically focused on learning how to address this fragmentation and improve the quality of mental health services for specific populations, namely the uninsured, homeless, and under-represented ethnic populations (UREP) [3, 4, 11]. Stakeholders identified healing system fragmentation, which disproportionately affects underserved groups, as the highest priority [5]. The plan was developed through an extensive community participation process that sought innovative strategies to address fragmentation and deliver recovery-based services [4]. The plan proposes four models designed to integrate mental health services with physical health and substance abuse care: 1. Integrated Clinic Model: Combines mental health, physical health, and substance abuse services in community-based sites like primary care or mental health clinics [4, 10]. This aims to increase access by bringing services to locations people already frequent, reduce stigma associated with formal mental health settings by integrating them into primary care, and improve service quality through coordination [9, 10, 12-14]. The model supports treating serious mental illness within primary care settings [5, 15] and uses a “warm hand-off” approach between providers [16]. It requires licensed mental health providers on site [17, 18]. 2. Integrated Mobile Health Team Model: A mobile, multi-disciplinary team integrates physical health, mental health, and substance abuse services specifically for individuals with mental illness who are homeless or have recently moved into permanent supportive housing [19, 20]. This model addresses the fragmentation specific to the homeless population and provides a client-centered, housing-first approach with harm reduction strategies [21, 22]. It aims to improve mental health outcomes and reduce homelessness [23]. 3. Community-Designed Integrated Service Management (ISM) Model: Explicitly focuses on UREP communities by integrating formal (including mental health) and non-traditional services based on the community’s definition of care [24, 25]. Services are grounded in ethnic communities and their natural support systems [25]. This model addresses specific barriers UREP face in accessing traditional mental health services, such as stigma, mistrust, language differences, and lack of culturally appropriate care [12, 26]. It uses culturally competent service integrators, including professionals and trained peers, and involves community-designed peer-based outreach, engagement, linkage, and advocacy [25, 27-29]. A core principle is that the public mental health system must adopt culturally competent and holistic strategies anchored in UREP communities that complement formal mental health services [30]. 4. Integrated Peer-Run Model: Uses a peer-driven approach to identify, obtain, and coordinate mental health, physical health, and substance abuse care for uninsured adults with mental health needs (including those who may be homeless, UREP, or from other sub-populations) [31-34]. It incorporates Peer-Run Integrated Services Management (PRISM) as a client-driven alternative to traditional community mental health services and Alternative Peer-Run Crisis Houses as alternatives to hospitalization for mental health crises [32, 34-36]. The model aims to more effectively integrate peer-run programs into the public mental health system [32, 36]. Peer teams coordinate the provision of clinical services [34]. Specific challenges related to integrating mental health services highlighted in the sources include: • Working across different settings, systems, and agencies [6-8]. • Limited capacity for communication, coordination, and information sharing among programs and providers [37]. • Integrating disparate funding streams for sustainable programs [37-40]. • Difficulties incorporating non-traditional practitioners, such as American Indian healers, into the formal mental health system regarding credentialing and billing [41-43]. • Stigma surrounding mental illness and mistrust of formal treatment settings, particularly within UREP communities [12, 26, 44]. • Providing culturally and linguistically competent mental health services countywide [26, 45]. • A lack of alternatives to costly institutional options for people experiencing a mental health crisis [32, 36]. • Difficulties fully integrating peer-run programs into the public mental health system [32, 36]. • Addressing funding gaps, such as the lack of dedicated funding for supportive services in permanent supportive housing for the mentally ill homeless [40]. The Innovations Plan aims to learn how to overcome these barriers [42, 43, 46-49]. Evaluation of the models will assess the extent of integration achieved, service levels and access to mental health services, quality of care and outcomes (including mental health outcomes), stakeholder satisfaction (including clients and providers), and cost-effectiveness [8, 14, 39, 46, 47, 50-57]. The learning questions specifically address aspects like the effectiveness of integrated models for treating individuals with mental health needs alongside other conditions, utilizing ethnic community resources, the role of peers, and the impact on stigma [38, 41, 44, 51, 53, 58-65]. Ultimately, the plan seeks to inform future system changes to better serve vulnerable populations with mental health needs [11, 60].)* * Appendix E: Biographies of Key Personnel (Placeholder for Ocean Duran, etc.) * **Supporting Evidence:** > *(Information about Ocean Duran can be drawn from LAbizPlan.txt – Mental Health Innovation Timeline and Participants – Cast of Characters, and the authorship notes in LAbizPlan2.txt. 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