LA County Board

18.\nReforming and Integrating Mental Healthcare within the County’s\nHomeless Services System\nRecommendation as submitted by Supervisors Horvath and Barger: Instruct the\nDirector of Mental Health, in consultation with the Acting Chief Executive Officer\nand the Director of Homeless Services and Housing to:\nIdentify and implement the appropriate Department of Mental Health\n(DMH) items to designate a team of staff assigned to collaborate with the\nDepartment of Homeless Services and Housing (HSH) to ensure that\npeople with Severe Mental Illness (SMI) who are experiencing\nhomelessness are assessed and provided all appropriate DMH\nadministered and funded services for which they are eligible, and to\nsupport DMH’s leadership in a whatever-it-takes approach to providing\ncare designed to meet the behavioral health needs of people\nexperiencing homelessness. The team will report to DMH’s Deputy\nDirector of Countywide Engagement Division, will have experience\nworking with people experiencing homelessness and/or lived experience\nof homelessness, and will be responsible for the following:\nWorking with HSH and homeless service provider agencies\n(including agencies that are contracted by DMH as well as\nagencies that are not contracted by DMH) to address and resolve\nproblems with specific client cases, including barriers to DMH\nenrollment, accessing street-based care and care in interim and\npermanent housing, and accessing the appropriate level of care.\nPerforming case review meetings on a regular basis that include\nDMH clients and those who have been referred to DMH but are not\nyet receiving services. Case reviews will allow the DMH and HSH\nteams to identify challenges related to specific client cases, review\noptions for addressing the client’s needs, and resolve roadblocks.\nFormulating and implementing process improvements for\nprogrammatic and systemic changes required to address the\nroadblocks identified in the case review meetings.\nAppoint DMH’s current Deputy Director of Countywide Engagement\nDivision as the Department’s Homeless Services Liaison and\nCoordinator. This Deputy Director will be responsible for facilitating and\nprioritizing the collaboration with HSH to identify and develop solutions to\nsystemic barriers that impede access to services. This includes, but is\nnot limited to, the following cross-departmental actions:\nWorking closely with people with lived experience of\nhomelessness, community-based homeless service providers, and\nlocal jurisdictions to develop effective solutions informed by the\nrealities and barriers evidenced in program implementation.\nCreate a stronger planning relationship between DMH and HSH for\nthe development of programming funded by DMH that supports the\nwork to address homelessness, including BHSA, BHBH, etc. Such\nintegrated planning will equip the County to provide a more\ncomprehensive and effective approach to homeless services,\npreventing duplication, creating more specialized interventions,\nand leveraging all resources.\nTo the extent possible and as allowed under regulations, make\nrecommendations for DMH’s directly operated and contracted\nprograms to better meet the needs of people who are homeless.\nMake recommendations in collaboration with DMH’s Housing\nDivision, Outpatient Care Services, and FSP Administration and\nHSH to improve access to housing and behavioral health services\nfor people experiencing homelessness, engaging and following up\non the streets, in interim housing sites, and in locations that make\nit easier for the client to access care without requiring visits to\nbrick and mortar sites.\nInstruct the Director of Homeless Services and Housing to report back to the\nBoard in writing in 90 days listing the steps needed to become a Full Service\nPartnership (FSP) provider and the timing required, and direct DMH to provide\nsupport and consultation.\nInstruct the Director of Mental Health and the Director of Public Health\nSubstance Abuse Prevention and Control (DPH-SAPC), to explore ideas to\nsupport the County’s public behavioral health system’s workforce pipeline. This\nshould include consideration of ongoing advocacy with the State regarding the\nState’s plans to administer Behavioral Health Workforce Investment funds, as\nwell as recommendations for legislative and regulatory advocacy that would\nenhance the public behavioral health system workforce. The Departments can\nreport back as part of the Departments’ ongoing reports title “Investing in\nStrengthening the County Healthcare Workforce.”\nInstruct the Director of Mental Health to take the following actions:\nEnsure that HSH has referral pathways to DMH funded, managed and\nadministered housing intervention resources for individuals who DMH\ndetermines meet Specialty Mental Health and other eligibility criteria.\nReferrals can be made through existing or jointly developed referral\nprocesses such as Air Traffic Control at Emergency Centralized\nResponse Center (ECRC), and DMH should seek to quickly assess\nreferred clients not already enrolled in DMH services. DMH should\nexplore pathways to increase access to DMH housing, including for\nindividuals who self-identify or show indications of serious mental illness,\nor are referred by non-DMH licensed clinicians.\nContinue to work collaboratively with HSH to identify care and treatment\ngaps for people experiencing homelessness with serious mental illness,\nwhether the individual is already receiving services from DMH or not, and\nidentify funding opportunities. Examples include working with HSH to\nmaximize CalAIM Enhanced Care Management (ECM) and Community\nSupports funding for people experiencing homelessness to expand the\nCounty’s ability to serve PEH.\nInvite HSH to educate stakeholders, including the BHSA community\nplanning process partners and the Behavioral Health Commission, on the\ngoals around regional homeless alignment and the critical role of\ninvestments in behavioral health funding for people experiencing\nhomelessness. HSH will also ensure that the regional Measure A goals\nand Standards of Care are shared with DMH’s stakeholders and\ncontractors, so that all parties can understand DMH’s role in meeting\nthese regional goals and so that DMH can incorporate these metrics into\nfuture DMH contracts.\nCollaborate with DPH-SAPC and HSH leadership to inform advocacy on\nBehavioral Health Services Act (BHSA), and other State or Federal\nfunding and policy to support people experiencing homelessness.\nIn partnership with HSH, engage the local Managed Care Plans (MCPs)\nto ensure that there is a shared understanding amongst all parties of how\nthe responsibilities for providing mental health care services are\ndelineated between DMH’s Specialty Mental Health Plan and the MCPs.\nDevelop and scale pathways to connect clients to the appropriate\ntreatment provider.\nContinue to identify opportunities to better leverage funding internally,\nand in collaboration with DPH-SAPC, HSH and other County\nDepartments. For instance, DMH to provide more training for staff and\ncontractors about how to code and bill appropriately to ensure that the\nCounty is drawing down the maximum amount of leveraged funding\navailable. To the extent that this additional responsibility is beyond the\nrequired obligations of the DMH, DMH will work with CEO to request\nadditional staff to do this work.\nProvide additional training to all DMH directly operated and contracted\nstaff on how to creatively and effectively engage and work with people\nexperiencing homelessness - with a particular focus on how to enroll and\nbill for clients.\nEnsure that DMH public facing staff from all programs have the training,\nresources, and connections to service area navigation teams necessary\nto effectively refer to the full continuum of DMH and HSH services.\nExplore with HSH and homeless service providers how to train staff and\nintegrate Multidisciplinary Teams to better connect unhoused individuals\nliving on the street to mental health services, whether provided by DMH, a\nmanaged care plan, or HSH.\nIn consultation with County Counsel revise protocols to streamline the\nsharing of client information within the cross departmental care teams.\nIncrease training for DMH staff, contracted providers, and stakeholders\non HIPAA regulations.\nClearly define the role of Full Service Partnership (FSP), including the\nHomeless Services and Supports Program (HSSP) in the continuum of\nbehavioral health care being provided to people experiencing\nhomelessness and build out a robust system to monitor and ensure that\nFSP and HSSP providers are in compliance with contract requirements\nthat provide effective, appropriate, field-based delivery of the network of\nFSP and HSSP services, resources, and interventions. DMH will conduct\nsite visits, file reviews, and ongoing performance management to monitor\ncompliance and provide technical assistance to FSP providers.\nExplore opportunities for Field Medicine Providers to become FSP\nproviders.\nAs funding allows, continue to expand the Interim Housing Outreach\nProgram (IHOP) across the County and continue to monitor this program\nto ensure that clients are receiving optimal care and services. Through\nthis program, DMH is better positioned to assess and serve individuals\nwho require access to DMH funded services and housing interventions\nbut are not yet a part of the DMH system of care.\nContinue to analyze and improve contracting processes and compliance\npolicies and meet with providers to provide guidance, technical\nassistance, incentives and consequences to improve service delivery.\nProvide all necessary data on referrals, services, and outcomes that are\nnecessary for the ongoing Measure A progress monitoring to HSH.\nExplore and define metrics that can be used to track the progress and\noutcomes of this motion.\nInstruct the Director of Mental Health in collaboration with the Director of\nHomeless Services and Housing, to report back to the Board in writing in 90\ndays and bi-annually thereafter, on the status of implementing the directives\nlisted above, including measurement metrics and outcomes when identified.\nDirect the Acting Chief Executive Officer in consultation with the Chief\nInformation Officer, Directors of Homeless and Housing Services, Mental\nHealth, Public Health through the SAPC, Health Services, County Counsel, and\nother County Department Heads to take the following action:\nImprove data sharing within County Departments, managed care plans,\nstakeholders, and partners.\nIn collaboration with the Acting Chief Executive Officer, through its\nLegislative Affairs and Intergovernmental Branch, to identify opportunities\nfor State and Federal advocacy to improve data sharing practices.\nRevise protocols to streamline the sharing of client information within the\ncross departmental care teams.\nReport back to the Board in 90 days on progress and annually thereafter.\n(26-1585)\nMotion by Supervisor Horvath\nMotion by Supervisors Horvath and Barger (Updates Following Cluster)