LA County Board

18. Reforming and Integrating Mental Healthcare within the County’s Homeless Services System Recommendation as submitted by Supervisors Horvath and Barger: Instruct the Director of Mental Health, in consultation with the Acting Chief Executive Officer and the Director of Homeless Services and Housing to: Identify and implement the appropriate Department of Mental Health (DMH) items to designate a team of staff assigned to collaborate with the Department of Homeless Services and Housing (HSH) to ensure that people with Severe Mental Illness (SMI) who are experiencing homelessness are assessed and provided all appropriate DMH administered and funded services for which they are eligible, and to support DMH’s leadership in a whatever-it-takes approach to providing care designed to meet the behavioral health needs of people experiencing homelessness. The team will report to DMH’s Deputy Director of Countywide Engagement Division, will have experience working with people experiencing homelessness and/or lived experience of homelessness, and will be responsible for the following: Working with HSH and homeless service provider agencies (including agencies that are contracted by DMH as well as agencies that are not contracted by DMH) to address and resolve problems with specific client cases, including barriers to DMH enrollment, accessing street-based care and care in interim and permanent housing, and accessing the appropriate level of care. Performing case review meetings on a regular basis that include DMH clients and those who have been referred to DMH but are not yet receiving services. Case reviews will allow the DMH and HSH teams to identify challenges related to specific client cases, review options for addressing the client’s needs, and resolve roadblocks. Formulating and implementing process improvements for programmatic and systemic changes required to address the roadblocks identified in the case review meetings. Appoint DMH’s current Deputy Director of Countywide Engagement Division as the Department’s Homeless Services Liaison and Coordinator. This Deputy Director will be responsible for facilitating and prioritizing the collaboration with HSH to identify and develop solutions to systemic barriers that impede access to services. This includes, but is not limited to, the following cross-departmental actions: Working closely with people with lived experience of homelessness, community-based homeless service providers, and local jurisdictions to develop effective solutions informed by the realities and barriers evidenced in program implementation. Create a stronger planning relationship between DMH and HSH for the development of programming funded by DMH that supports the work to address homelessness, including BHSA, BHBH, etc. Such integrated planning will equip the County to provide a more comprehensive and effective approach to homeless services, preventing duplication, creating more specialized interventions, and leveraging all resources. To the extent possible and as allowed under regulations, make recommendations for DMH’s directly operated and contracted programs to better meet the needs of people who are homeless. Make recommendations in collaboration with DMH’s Housing Division, Outpatient Care Services, and FSP Administration and HSH to improve access to housing and behavioral health services for people experiencing homelessness, engaging and following up on the streets, in interim housing sites, and in locations that make it easier for the client to access care without requiring visits to brick and mortar sites. Instruct the Director of Homeless Services and Housing to report back to the Board in writing in 90 days listing the steps needed to become a Full Service Partnership (FSP) provider and the timing required, and direct DMH to provide support and consultation. Instruct the Director of Mental Health and the Director of Public Health Substance Abuse Prevention and Control (DPH-SAPC), to explore ideas to support the County’s public behavioral health system’s workforce pipeline. This should include consideration of ongoing advocacy with the State regarding the State’s plans to administer Behavioral Health Workforce Investment funds, as well as recommendations for legislative and regulatory advocacy that would enhance the public behavioral health system workforce. The Departments can report back as part of the Departments’ ongoing reports title “Investing in Strengthening the County Healthcare Workforce.” Instruct the Director of Mental Health to take the following actions: Ensure that HSH has referral pathways to DMH funded, managed and administered housing intervention resources for individuals who DMH determines meet Specialty Mental Health and other eligibility criteria. Referrals can be made through existing or jointly developed referral processes such as Air Traffic Control at Emergency Centralized Response Center (ECRC), and DMH should seek to quickly assess referred clients not already enrolled in DMH services. DMH should explore pathways to increase access to DMH housing, including for individuals who self-identify or show indications of serious mental illness, or are referred by non-DMH licensed clinicians. Continue to work collaboratively with HSH to identify care and treatment gaps for people experiencing homelessness with serious mental illness, whether the individual is already receiving services from DMH or not, and identify funding opportunities. Examples include working with HSH to maximize CalAIM Enhanced Care Management (ECM) and Community Supports funding for people experiencing homelessness to expand the County’s ability to serve PEH. Invite HSH to educate stakeholders, including the BHSA community planning process partners and the Behavioral Health Commission, on the goals around regional homeless alignment and the critical role of investments in behavioral health funding for people experiencing homelessness. HSH will also ensure that the regional Measure A goals and Standards of Care are shared with DMH’s stakeholders and contractors, so that all parties can understand DMH’s role in meeting these regional goals and so that DMH can incorporate these metrics into future DMH contracts. Collaborate with DPH-SAPC and HSH leadership to inform advocacy on Behavioral Health Services Act (BHSA), and other State or Federal funding and policy to support people experiencing homelessness. In partnership with HSH, engage the local Managed Care Plans (MCPs) to ensure that there is a shared understanding amongst all parties of how the responsibilities for providing mental health care services are delineated between DMH’s Specialty Mental Health Plan and the MCPs. Develop and scale pathways to connect clients to the appropriate treatment provider. Continue to identify opportunities to better leverage funding internally, and in collaboration with DPH-SAPC, HSH and other County Departments. For instance, DMH to provide more training for staff and contractors about how to code and bill appropriately to ensure that the County is drawing down the maximum amount of leveraged funding available. To the extent that this additional responsibility is beyond the required obligations of the DMH, DMH will work with CEO to request additional staff to do this work. Provide additional training to all DMH directly operated and contracted staff on how to creatively and effectively engage and work with people experiencing homelessness - with a particular focus on how to enroll and bill for clients. Ensure that DMH public facing staff from all programs have the training, resources, and connections to service area navigation teams necessary to effectively refer to the full continuum of DMH and HSH services. Explore with HSH and homeless service providers how to train staff and integrate Multidisciplinary Teams to better connect unhoused individuals living on the street to mental health services, whether provided by DMH, a managed care plan, or HSH. In consultation with County Counsel revise protocols to streamline the sharing of client information within the cross departmental care teams. Increase training for DMH staff, contracted providers, and stakeholders on HIPAA regulations. Clearly define the role of Full Service Partnership (FSP), including the Homeless Services and Supports Program (HSSP) in the continuum of behavioral health care being provided to people experiencing homelessness and build out a robust system to monitor and ensure that FSP and HSSP providers are in compliance with contract requirements that provide effective, appropriate, field-based delivery of the network of FSP and HSSP services, resources, and interventions. DMH will conduct site visits, file reviews, and ongoing performance management to monitor compliance and provide technical assistance to FSP providers. Explore opportunities for Field Medicine Providers to become FSP providers. As funding allows, continue to expand the Interim Housing Outreach Program (IHOP) across the County and continue to monitor this program to ensure that clients are receiving optimal care and services. Through this program, DMH is better positioned to assess and serve individuals who require access to DMH funded services and housing interventions but are not yet a part of the DMH system of care. Continue to analyze and improve contracting processes and compliance policies and meet with providers to provide guidance, technical assistance, incentives and consequences to improve service delivery. Provide all necessary data on referrals, services, and outcomes that are necessary for the ongoing Measure A progress monitoring to HSH. Explore and define metrics that can be used to track the progress and outcomes of this motion. Instruct the Director of Mental Health in collaboration with the Director of Homeless Services and Housing, to report back to the Board in writing in 90 days and bi-annually thereafter, on the status of implementing the directives listed above, including measurement metrics and outcomes when identified. Direct the Acting Chief Executive Officer in consultation with the Chief Information Officer, Directors of Homeless and Housing Services, Mental Health, Public Health through the SAPC, Health Services, County Counsel, and other County Department Heads to take the following action: Improve data sharing within County Departments, managed care plans, stakeholders, and partners. In collaboration with the Acting Chief Executive Officer, through its Legislative Affairs and Intergovernmental Branch, to identify opportunities for State and Federal advocacy to improve data sharing practices. Revise protocols to streamline the sharing of client information within the cross departmental care teams. Report back to the Board in 90 days on progress and annually thereafter. (26-1585) Motion by Supervisors Horvath and Barger (Updates Following Cluster)