Mental Health Board meeting minutes - County of Sonoma

Sonoma County
Mental Health Board Minutes
May 15, 2012
Norton Center West Wing Conference Room, Santa Rosa
www.sonoma-county.org/mhboard
(Minutes are posted in draft form and after approval)
Email: dhs-mhb@sonoma-county.org
Please Note: A list of commonly used abbreviations and acronyms is attached
CALL TO ORDER
Meeting called to order at 5:00 PM by Sherry Weyers for Doug Stephens, Chair
ROLL CALL
Present: Sharon Hardcastle, Ron Miller, Kathy Smith, Mary Ann Swanson, Sherry Weyers
Absent: Lyndal-Marie Armstrong, Maureen Casey, Mali Lopez, Doug Stephens, Karen Theobald, Rochelle Torre
Public: Megan Rooney and Sheridith Maresh (CFSA), Grace Harris (CPI), Laurie Petta (Goodwill), David France
(NAMI), Christa Seghezzi, Katrin Ciaffa (Buckelew), Carol Rankin, Sally Steinhart (Community Members),
Justin Hester (Tsunami)
Board of Supervisors Liaison to the MHB: Mike McGuire (absent)
Sonoma County Mental Health: Mike Kennedy, BH Director; Michael Lucid, ASO II; Denise Hunt and John Kolhoven,
Section Managers; Marty Marcus, Quality Improvement; Hank Hallowell, Patient Rights Advocate and Liaison to the
MHB; Virginia Meyer, Clerk to the MHB
ANNOUNCEMENTS /PUBLIC INTRODUCTIONS & COMMENTS
1) REMINDER: The June 19 th meeting will be a Public Hearing on the MHSA Update, to be held at the Finley
Center in Santa Rosa at 5:00 PM.
2) Currently there are vacancies in Districts 2 (Petaluma), 3 (Santa Rosa), and 4 (North County). If you live in one of the
districts with openings and are interested in serving on the Board, please contact Hank Hallowell, (565-4978 or
Hank.Hallowell@sonoma-county.org ). These contacts are also listed in the minutes in the packets available at the
back of the room.
3) You may submit agenda items for consideration prior to the Executive Board meeting, normally held on the first
Wednesday of each month, 10:30 to Noon. Email or call MHB clerk Virginia Meyer (565-4850),
Virginia.Meyer@sonoma-county.org to verify the next meeting date.
APPROVAL OF MINUTES
The Minutes of April 17 th could not be approved in the absence of a quorum.
SPECIAL PRESENTATION – Tsunami Enterprises - Justin Hester, Representative Payee Agent
[ info@tsunami-enterprises.org]
Michael Lucid set the context before introducing Justin Hester. He said the County used to provide payee services but it
was difficult, so they searched for a company to take over those. The relationship is between the client and Tsunami, and
not really with Behavioral Health. A small number of clients have so little income that the $38 monthly fee would
seriously deplete their funds needed for basic expenses. In those cases, BH pays the monthly fees.
Justin said Tsunami Enterprises is recognized by the Social Security Administration (SSA) and the Veterans
Administration (VA) as an Organizational Payee. Using the client’s monthly allotment, Tsunami typically pays their rent,
food, and pharmacy bills. Also, many clients have old debts that pre-date their use of a payee service, so Tsunami
sometimes must negotiate with the debt holder. They might request a waiver for SSI recipients, but they must try to
negotiate small monthly payments for SSDI recipients.
Contact with clients is done by whatever method fits the client’s needs: telephone, email, or face-to-face at sites such as
Interlink or COTS.
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Some clients can manage their food budget, but not rent and utilities. Tsunami staff are open to different approaches for
different clients. The VA themselves, without outside information (doctors, courts, etc), determine if the veteran needs
assistance. The VA also sets the budget, not the assigned fiduciary, and it requires a separate bank account. The VA does
not allow the use of a collective trust account. Their system is very different from the Social Security system. With SSA,
justification is needed for requesting assistance, and once the need is clear, the client does not have a choice whether or
not to have a payee. With VA, justification is also needed for requesting assistance, and once that need is clear, consumers
can choose a family member or an agency. BH recommends Tsunami to their clients who prefer an agency. Once SSA
decides a payee is needed, they can recommend the payee; others who can recommend a payee are doctors, the courts,
caseworkers, or organizations that work with people who have a disability income and have difficulty managing rent and
utility bills, such as Buckelew or COTS. SSA authorizes Tsunami to collect $38/month or 10% of benefits, whichever is
less.
About 490 Sonoma County residents are Tsunami clients; 290 are open to Behavioral Health.
Besides a family or an agency, the payee can be a neighbor or any non-felon; payees don’t even have to live in the same
state, although that situation can complicate things.
Tsunami’s contract with BH is only for clients who otherwise couldn’t pay the fee, and that totals 20-30 individuals.
Most clients are SSI, with an average income of about $854/month. If the client receives food stamps, the check is about
$200 less. Some clients get SDI along with SSI and receive $874/month. A few SDI-only clients receive $1500-
$1700/month, but most receive $1,000/month and free MediCal with no share of cost. If they receive over $1,180/month
there’s no free MediCal.
Tsunami has a staff of five, and as representative payees have no power of attorney to sign documents on behalf of clients.
They can, however, fill out MediCal forms for signature by the conservator or the client.
A question was asked about communication with family members, and Justin said they ask for it up front, but some clients
are not willing. In general, Tsunami must have written consent to speak to family, and can disclose no details.
Another question asked what happens if a person has knowledge of SSI funds being used inappropriately, as in the
example of a liquor store holding the funds and giving alcohol to the client. Justin said Social Security doesn’t police the
use of funds, but if proof is submitted, the client’s benefits will be suspended and the abuser won’t be prosecuted.
Social Security checks are auto-deposited to Tsunami’s big trust account, and they write paper checks to the client for
tracking purposes. Social Security audits biannually, and Behavioral Health has access to Tsunami’s database.
Justin recommends that clients have savings accounts, because debit cards are not issued with those, creating fewer
opportunities for anyone to take advantage of clients.
Tsunami manages only Social Security and Veterans Administration funds, because as a non-profit, they can’t contract
with others for financial management.
A client gets off representative services through the reverse of the process. Doctors, the caseworker, etc. can make the
recommendation, and if he knows about the recommendation ahead of time, Justin tries to transition the clients to paying
their bills on time. Some end up back with Tsunami three months later because being responsible for paying bills is more
stress than they can handle. Hank Hallowell said a Client Plan Goal is now ”To get off Rep Payee.”
A member asked if the family is contacted when there is “too much” money in the account to comply with SSI
requirements. Justin said they try to do that but don’t always have family contact info. She said it would be nice to get
acknowledgment from the rep payee that the family is working to help clients.
Another member asked if, at the initial meeting, the client be offered a consent for allowing Tsunami to talk to creditors
and utilities. Justin said they do have the power to make sure utilities are not turned off.
Tsunami serves about 1,300 clients in Mendocino, Lake, Sonoma, Napa, and most recently, Solano counties. The name
Tsunami was chosen as it was the name of a previous business run by the founder, and because life can be overwhelming.
They try to help.
ACTION ITEM None tonight
BOARD PLANNING Sherry reminded members that a nominating committee is needed, and that will be a June
Executive Committee agenda item.
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REPORT OF BEHAVIORAL HEALTH DIVISION DIRECTOR Mike Kennedy, MFT
Mike said the Governor’s May Budget Revise came out yesterday and is still being analyzed. Health and Human Services
as well as Education are still at risk. If the Governor’s tax increases are not passed, pre-set “triggers” will cause more cuts.
There are many changes at the State Level. DMH duties are going to the Department of Health Care Services (DHCS),
and the State Department of Alcohol and Drug Programs is probably going away. There are lots of discussions around
who will assume oversight.
In fiscal year 2012/2013 we’re trying to keep things flat, with no reductions. We’re all right for the moment, and will
continue tracking issues at the State level as we do every year, and try to stay ready in case more cuts are coming.
We just finished the 10 th Crisis Intervention Training (CIT) Academy, for a total of 300 law enforcement deputies and
officers who have learned to intervene effectively with someone in the middle of a mental health crisis. The Sheriff has
138 trained deputies out of approximately 150 on the street. Santa Rosa Police Department has 90 of about 120 now
trained in CIT techniques.
CIT is a 32-hour, four-day training that features lectures from experts, tours of behavioral health programs, various roleplaying
vignettes with hands-on practice, a Returning Vets panel, a panel of Consumers, a panel of Family Members, and
more. An entire day is spent on mental health diagnoses. Sending officers is a huge commitment for agencies, because the
attending officers’ shifts must be covered. Even so, Mike said some of the smaller jurisdictions have managed to send
officers over the past five years, including Sebastopol (12), Rohnert Park (8), SRJC (6), Petaluma, and even 2 from the
CHP. Reportedly, CIT-trained officers are able to talk more about symptoms, know when medical clearance is needed,
have better-written 5150s, and know when to divert appropriately rather than jailing clients. Mike said PES has noted a
difference in how these officers treat people.
The comprehensive curriculum has been developed over time and is the most intensive training they can get. Mike said he
can see the change in people over the course of the week as they begin to embrace the techniques. A MHB member who
served on the Family Panel said, “We touch them on a professional and personal levels,” and they talk to her about their
family members.
Mike said the relationships we’ve built with all these agencies are helping the way our clients are treated by law
enforcement out in the community.
Sheridith Maresh, manager of the Empowerment Center in Guerneville, read a letter from a Sheriff’s deputy about a
recent incident there:
"Thank you for your opinion on how we addressed the [member] incident. The Sheriff's office really wants to
serve the community adequately and has emphasized compassion in dealing with subjects in emotional crisis.
Your opinion of our involvement with [the member] is heavily weighed, considering your position.
Coincidentally, I saw her walking near Safeway several days later and stopped to say ‘hello’. She was very
polite and appreciative to me for treating her ‘respectfully’. After briefly talking with her, I felt like I had
‘helped’ her. As I drove away, I smiled and felt good about my ability to be there. I felt like I actually made a
difference. That is very rewarding!"
An audience member asked if the Board of Supervisors has designated any facilities under the Lanterman-Petris-Short Act
[ http://www.leginfo.ca.gov/cgi-bin/displaycode?section=wic&group=04001-05000&file=5000-5120 ], and Mike replied that PES is so
designated.
Mike said we’re hiring to fill thirty vacancies. A lot of students are graduating from SSU, and we’re getting more
bilingual/bicultural staff. We supported the Student Mental Health Initiative
[www.dmh.ca.gov/.../StudentMentalHealthInitiative.asp] and have made a proposal with SSU and SRJC for student peer
counselors. SSU has a project focused on returning vets.
MH SYSTEMS TRANSFORMATION Section Managers
Sonoma County’s Mental Health Services Act [MHSA] page is at www.sonoma-county.org/mhsa
The State’s MHSA page is at http://www.dmh.ca.gov/Prop_63/MHSA/default.asp
Denise Hunt, RN, MSN, Acute/Forensics Section Manager - PES is offering smoking cessation options to clients, a major
initiative in partnership with the Department of Health Services.
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The FACT program started a Client Council four years ago, and they recently decided to build a raised bed garden outside
the offices at 2350 Professional Drive. Please feel free to drive by to see it. The clients work it and we supply the
materials. Clients also chose the plants and will have communal meals with the produce. We see this as a way of teaching
healthy eating habits.
The Older Adult Team participated in stateside trainings on Best Practices.
Starting Point sent four staff to Cognitive Behavioral Therapy training for in-custody offenders, under the AB109 mandate
to keep low-level offenders in their communities and give them treatment them rather than sending them to prison.
The Mobile Support Team has identified liaisons to law enforcement and DAAC, has a manager identified, and will be
hiring the team. Team members will be licensed and some will be bilingual. When they go out on a crisis call, a team
member will stay behind with the family to explain the process and offer support and resources. A board member said that
the follow-up piece is the part she’s especially excited about. This program will start small and in a limited area at first,
and it will involve the police chaplaincy program.
John Kolhoven PhD, Adult Services, CAPE Team, and Youth & Family Section Manager - John said it’s exciting that we
have 33 new staff - including many interns - beginning a five-week orientation process.
On the children’s side, Human Services and Probation are working in collaboration with Youth Services. As of May 1 st ,
Jennifer Morehouse MFT has been embedded full time in Human Services to screen kids 5-18 years. In the first week she
identified seven kids and referred them to services. These are kids that we ordinarily would never see. CPI is also working
with that population.
We’re coming to the end of the MOU (Memorandum of Understanding) with SELPA. We have benefitted by having a
good relationship with them and are open to continuing to work with them.
A member of the audience praised his positive experience with the CAPE Team. He said he was impressed with the
quickness of their response. They were at the school in ten minutes, and the student was taken to PES for help.
REPORT FROM THE CHAIR
None tonight, but Sherry thanked all those in the community who work with Behavioral Health.
OTHER REPORTS
Sherry will be forwarding an email from CALMHB regarding a meeting and three webinars that members might find
interesting.
She said CBS 5 news last night featured Santa Clara’s Judge Stephen Manley, a speaker at NAMI conventions, who
talked about veterans in his courtroom and how he works with them. His is the first Veterans Mental Health Court in the
nation, and soon there will be a second one in San Mateo.
BOARD DISCUSSION / PUBLIC COMMENTS
None tonight.
Meeting adjourned at 6:57 PM
Respectfully submitted,
Virginia Meyer, Mental Health Board Clerk
Virginia.Meyer@sonoma-county.org
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ABBREVIATIONS & ACRONYMS
5150
Declared to be a danger to self and/or others
AB3632 Assembly Bill - State-mandated MH services for seriously emotionally disturbed youth
ACT Assertive Community Treatment (run by Telecare)
ANSA Adult Needs and Strengths Assessment – a “tool” for determining which services are needed by each particular adult client
AODS Alcohol and Other Drugs Services – now a part of the Mental Health Division
CANS Child, Adolescent Needs and Strengths (Assessment) – helps determine which services are needed by each child client
CAPE Crisis Assessment, Prevention, and Education Team; goes into the schools when called to intervene
CHD California Human Development
CIP Community Intervention Program
CIT Crisis Intervention Training (for law enforcement)
CMHC Community Mental Health Centers (SCMH))
ConREP Conditional Release Program (State-funded)
CR Crisis Residential (aka Progress Sonoma-temporary home for clients in crisis, run by Progress Foundation )
CS Crisis Stabilization – within PES - see PES (up to 23 hours)
CSN Community Support Network (contract Provider)
CSS Community Services and Support (part of Mental Health Services Act-MHSA)
DAAC Drug Abuse Alternatives Center
DHCS (State) Department of Health Care Services (replacing DMH July 1, 2011)
DHS Department of Health Services (Sonoma County)
DMH State Department of Mental Health in Sacramento – being disbanded in FY11/12
EPSDT Early Periodic Screening, Diagnosis & Treatment (Children’s MediCal)
FACT Forensic Assertive Community Treatment
FASST Family Advocacy Stabilization, Support, and Treatment (kids 8-12)
FQHC Federally Qualified Health Center
HSD Human Services Department
IHT Integrated Health Team (medical and MH services for adults)
IPU Inpatient Psychiatric Unit
IRT Integrated Recovery Team (for those with mental illness + substance use issues)
IMDs Institutes for Mental Disease (residential facilities for those unable to live on their own)
INN Innovation (part of MHSA)
LG Los Guilucos-Juvenile Hall
LGBQQTI Lesbian/Gay/Bisexual/Queer/Questioning/Transgender/Intersexed (also LGBT)
MADF Main Adult Detention Facility (Jail)
MHB Mental Health Board
MHD Mental Health Division (Sonoma County)
MHSA Mental Health Services Act
MST Mobile Support Team
NAMI National Alliance on Mental Illness
NBSP North Bay Suicide Prevention Project
PC1370 Penal Code 1370 (Incompetent to Stand Trial, by virtue of mental illness)
PES Psychiatric Emergency Services – open 24/7 for psychiatric crises - 3322 Chanate Road
PEI Prevention and Early Intervention (part of Mental Health Services Act-MHSA)
PPSC Petaluma People Services Center
QI Quality Improvement - Marty Marcus and Wendy Sanders
QIP Quality Improvement Policy (meeting)
QIS Quality Improvement Steering (meeting)
QIC Quality Improvement Committee (meeting)
RCC Redwood Children’s Center
RCL Rate Classification Level (12, 13, 14 - group home designations)
RFP Request For Proposals (released when new programs are planned and contractors are solicited)
SCMH Sonoma County Mental Health
SCOE Sonoma County Office of Education
SELPA Special Education Local Plan Area
SPMI Serious Persistent Mental Illness (or Seriously Persistently Mentally Ill)
SYC Sierra Youth Center
TAY Transition Age Youth (18-25)
VOMCH Valley of the Moon Children’s Home
WET Workforce Education and Training (part of MHSA)
WRAP Working to Recognize Alternative Possibilities
WRAPAROUND Community-based intervention services that emphasize the strengths of the child and family
YS/Y&F Youth Services/Youth & Family (Sonoma County Mental Health)
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