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Office of Statewide Health Planning and Development 1.

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1 Office of Statewide Health Planning and Development 1

2 Agenda ItemLeadTime Welcome and Plan Development Process Overview Robert P. David Lupe Alonzo-Diaz 10min Needs Assessment PresentationResource Development Associates (RDA) 25min Five-Year Plan PresentationSergio Aguilar20min Five-Year Plan Budget PresentationSergio Aguilar Michael Wimberly 15min Questions/Discussion/ ApprovalLupe Alonzo-Diaz55min 2 Office of Statewide Health Planning and Development

3 In 2008, the former Department of Mental Health (DMH) developed and received approval by the California Mental Health Planning Council for the first WET Five- Year Plan that covered the period from April 2008 to April 2013. In July 2012, following the elimination of DMH, the MHSA WET programs were transferred to OSHPD. OSHPD is accountable for the development of the next WET Five-Year Plan. This allowed the opportunity to provide changes to allocations for the State WET Programs funded through the first Five-Year Plan. Per WIC Section 5820 (e), the Five-Year Plan requires final approval from the California Mental Health Planning Council (CMHPC) by April 2014. To develop a comprehensive plan, OSHPD carried out a robust process that included stakeholder engagement and independent research, evaluation, and analysis on public mental health workforce trends and needs. 3 Office of Statewide Health Planning and Development

4 Community Forums: OSHPD completed 14 community forums throughout the state including: Napa, Ventura, San Diego, Humboldt, Alameda, Los Angeles, Stanislaus, Shasta, Sacramento, Butte, Orange, San Bernardino, Monterey, and Tulare. Collectively these community forums engaged over 600 stakeholders throughout the state. Focus Groups: OSHPD conducted 13 focus groups with stakeholder groups during their established stakeholder meetings which included: California Healthcare Workforce Policy Commission; MHSA WET Coordinators; MHSA Partners Forum; California Health Professions Consortium/California Health Workforce Alliance; Working Well Together; Foundation Board of Trustees; WET Regional Partnership Coordinators; Greater Bay Area WET Collaborative; CMHDA Policy Committee; CMHDA all Directors Meeting; Older Adults Population Stakeholders; California Coalition for Mental Health; and California Mental Health Planning Council. Webinar and Online Survey: Released an online survey on May 28 and conducted a webinar on May 29 to gather feedback from stakeholders who were unable to attend and/or participate in other stakeholder engagement meetings. OSHPD received over 300 survey responses and 26 participants attended the webinar. Stakeholder Interviews: Conducted telephone interviews with 13 stakeholders. Office of Statewide Health Planning and Development 4

5 5 WET Five Year Plan Advisory Sub-Committee and WET Advisory Committee: Engaged committee stakeholders and public members to obtained feedback that helped inform the draft WET Five-Year plan via 3 meetings with the WET Five-Year Plan Advisory Sub-Committee, 5 meetings with the WET Advisory Committee meetings. Career Pathways: Engaged stakeholders through the reconvening of the Career Pathways Sub-Committee which is charged with developing career pathways and recommendations for select public mental health occupations including: Psychiatrists; Marriage and Family Therapist (MFT); Clinical Psychologist; Psychiatric Mental Health Nurse Practitioner/Clinical Nurse Specialist; School Psychologist; Peer Support Specialist; Licensed Professional Clinical Counselor; and Alcohol and other Drug Abuse Counselors. The development of career pathways for mental health professions will help to inform the WET Five-Year Plan. Statewide Conference Call Forums: Provided stakeholders an opportunity to provide feedback on the draft plan via a 2 all day statewide conference call forum. Over 100 stakeholders called in to the conference call forum. Open Public Comment Period: Provided stakeholders opportunity to provide feedback on Draft WET Five-Year Plan through an open public comment period. Received 32 comments. Government Partners: Engaged OAC, DHCS, CMHDA, and CMHPC via 2 meetings to get feedback on the Draft WET Five-Year Plan

6 Office of Statewide Health Planning and Development 6 ActivityDate Stakeholder Engagement 14 Community Forums 13 Focus Groups 13 Stakeholder Interview WET Advisory Committee Meetings Survey December 2013 – July 2013 Released First Draft WET Five-Year PlanSeptember 12, 2013 Received Feedback from WET Advisory Committee, WET Five-Year Plan Advisory Committee, and members of the public September 19, 2013 Released Second Draft Five-Year PlanOctober 10, 2013 Received Feedback from California Mental Health Planning CouncilOctober 18, 2013 Released Third Draft WET Five-Year PlanOctober 30, 2013

7 Office of Statewide Health Planning and Development 7 ActivityDate CMHPC WET Five-Year Plan Workgroup Meeting#1November 4, 2013 Stakeholder Engagement on Draft WET Five-Year Plan Two day stakeholder conference call Forum Open public Comment Period November 4, - November 14, 2013 Government Partners Workgroup Meeting #1November 21, 2013 Received feedback from Mental Health Services Oversight and Accountability Commission November 21, 2013 Released Fourth Draft Five-Year PlanDecember 6, 2013 Received final feedback from WET Advisory Committee, WET Five-Year Plan Advisory Committee, and members of the public December 13, 2013 Government Partners Workgroup Meeting #2December 19, 2013 CMHPC WET Five-Year Plan Workgroup Meeting #2January 6, 2014 Present Final WET Five-Year Plan to California Mental Health Planning Council for Approval January 17, 2014 Submit Spring Finance Letter to Department of FinanceJanuary 17, 2014

8 Office of Statewide Health Planning and Development 8 Planning Council WET Workgroup Members John Ryan Cindy Claflin Jaye Vanderhurst Caron Collins Terry Lewis Dale Mueller Jane Adcock Government Partners: Mental Health Oversight and Accountability Commission County Mental Health Directors Association Department of Health Care Services California Mental Health Planning Council

9 Office of Statewide Health Planning and Development 10 WET Advisory CommitteeWET Five-Year Plan Advisory Sub-Committee Career Pathways Sub-Committee Molly Brassil Christa Thompson Cindy Claflin Chad Costello Jessica Cruz Brenda Grealish Cynthia Harrison Mary O'Connor Stacie Hiramoto Kevin Hoffman Kimberly Knifong Sharon Kuehn Kim Madsen Susan Mandel Kimberly Mayer Perfecto Muñoz Jeff Riel John Ryan Michele Peterson Adrienne Shilton Angelita Diaz-Akahori Steven Bush Ruben Cantu Viviana Amelia Criado David Folsom Celeste A. Jones Kimberly Knifong Sharon Kuehn Gustavo Loera Kim Madsen Miguel McQueen Poshi Mikalson Gloria Morrow Sheena Raji Andrée Reyes Melodie Schaefer Adrienne Shilton Trisha Stanionis Narkesia Swanigan Donna Ures Sandra Villano Linna Wang Tina Wooton Marianne Baptista Steve Barrow Cindy Beck David A. Cherin Sherry Daley Angel Galvez Rowena Gillo Cynthia Harrison Erynne Jones Kimberly Mayer Brandy Oeser Alejandra Postlethwaite Melodie Schaefer Adrienne Shilton

10 Office of Statewide Health Planning and Development 10 OSHPD contracted for assistance in conducting a statewide assessment of the workforce, education and training needs of Californias public mental health system which will be used to inform OSHPD in the development of the WET Five-Year Plan. Specifically the contractor will provide to OSHPD: Analysis of current State WET Administered Program outcomes; An analysis of the county-reported WET needs ; An analysis of feedback received during OHSPD-led stakeholder engagement; A literature review of information currently available on public mental health workforce shortages and corresponding educational and training capacity; An analysis of workforce supply and demand including estimates of long-term workforce needs.

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12 Office of Statewide Health Planning and Development The Office of Statewide Health Planning and Development (OSHPD) envisions a public mental health workforce, which includes consumers and family members, that is sufficient in size, diversity, skills and resources to deliver equitable, compassionate, culturally and linguistically responsive, age- appropriate, safe, timely and effective treatment, prevention, and early intervention services to individuals across the lifespan who are at risk for or experiencing the early onset of a serious mental illness across healthcare systems and settings. All services provided should be consumer and family driven, and promote wellness, recovery, and resilience for the people of California. Pg. 5. 12

13 Office of Statewide Health Planning and Development In collaboration with its stakeholders, OSHPD has developed a set of core values that guide all activities included in the Five-Year Plan: o Develop a licensed and non-licensed professional workforce, that includes diverse racial, ethnic, and cultural community members underrepresented in the public mental health system, and mental health consumers and families/caregivers, with the skills to: o Provide treatment, prevention, and early intervention services that are culturally and linguistically responsive to Californias diverse and dynamic needs; o Promote wellness, recovery and resilience and other positive behavioral health, mental health, substance use, and primary care outcomes; o Work collaboratively to deliver individualized, strengths-based, consumer-and family-driven services; o Use effective, innovative, community-identified, and evidence-based practices; o Conduct outreach to and engagement with unserved and underserved and inappropriately served populations; and o Promote inter-professional care by working across disciplines. Include the viewpoints and expertise of consumers and their families/caregivers in multiple healthcare settings Pg.6. 13

14 Office of Statewide Health Planning and Development The goals, objectives, and actions provide a framework on strategies state government, local government, community partners, educational institutions, and other stakeholders can enact to further efforts to adequately sustain and increase a qualified, diverse, and robust public mental health system workforce in California. Pg. 7 14

15 Office of Statewide Health Planning and Development The following actions support the implementation of all goals and objectives outlined in this section: o Continue engagement of Statewide WET Advisory Committee to support the implementation of state administered WET strategies. o Ensure focus and inclusion of target population across all WET programs including: consumers, family members, parents/caregivers, culturally diverse communities, and rural, underrepresented, underserved, unserved, and inappropriately served populations across the life span of age groups such as infants, children, adolescents, transition age youth, and older adults. o Ensure focus on MHSA values, principles, and priorities. o Ensure focus on innovative, evidence-based, and community-identified strategies. o Ensure continued evaluation of MHSA WET activities that is well-designed, data driven, and outcomes-based. o Ensure continued assessment of mental health workforce needs to guide priority WET strategies. Pg.7. 15

16 Office of Statewide Health Planning and Development Goal #1: Increase the number of diverse, qualified individuals in the public mental health system workforce to meet Californias diverse and dynamic needs. Goal #2: Expand the capacity of Californias incumbent public mental health workforce to meet California diverse and dynamic needs. Goal #3: Facilitate a robust statewide, regional, and local infrastructure to develop the public mental health workforce. Pg. 7-13 16

17 Office of Statewide Health Planning and Development Goal #1: Increase the number of diverse, qualified individuals in the public mental health system workforce to meet Californias diverse and dynamic needs. o Objective A: Expand awareness and outreach efforts to effectively recruit racial, ethnic, and culturally diverse individuals into the public mental health system workforce. o Objective B: Identify and enhance curricula to train students at all levels in competencies that align with the full spectrum of Californias diverse and dynamic public mental health service needs. o Objective C: Develop career pathways, ladders, and lattices for individuals entering and advancing across new and existing professions in the public mental health system. o Action 4: Establish statewide peer specialist certifications for consumers, parents/caregivers, and family members.* o Objective D: Expand the capacity of postsecondary education to meet the identified public mental health workforce needs. o Objective E: Expand financial incentive programs for the public mental health system workforce to equitably meet identified public mental health system needs in underrepresented, underserved, unserved, and inappropriately served communities. *CMHPC made a motion during the October 18 meeting to include this action. Pg. 7-10 17

18 Office of Statewide Health Planning and Development Goal #2: Expand the capacity of Californias incumbent public mental health workforce to meet California diverse and dynamic needs. o Objective A: Expand incumbent workforce education and training programs for incumbents in the public mental health workforce in competencies that align with the full spectrum of Californias diverse and dynamic public mental health service needs. o Objective B: Increase the retention of public mental health system workforce identified as high priority. o Objective C: Evaluate methods to expand and enhance the quality of existing public mental health service delivery systems to meet Californias diverse and dynamic public mental health needs. Pg. 10-11 18

19 Office of Statewide Health Planning and Development Goal #3: Facilitate a robust statewide, regional, and local infrastructure to develop the public mental health workforce. o Objective A: Develop and sustain new and existing collaborations and partnerships to strengthen recruitment, training, education, and retention of the public mental health system workforce. o Objective B: Identify, increase eligibility for, and secure federal healthcare workforce funding. o Objective C: Enhance the evaluation of mental health workforce, education, and training efforts to identify outcomes, best practices, and systems change. o Objective D: Explore policies identified by stakeholders during the WET Five- Year Plan development process that aim to further Californias efforts to meet its communities diverse and dynamic public mental health system needs. Pg. 12-13 19

20 Office of Statewide Health Planning and Development Government and non-government stakeholders within California will be investing considerable resources into improving the public mental health system workforce consistent with elements outlined in the WET Five-Year Plan 2014-2019. A means to evaluate the impact of these investments is critical in order to assess the effectiveness of the activities undertaken, determine whether the goals outlined in the WET Five-Year Plans are being met, and re-evaluate future priorities and actions. Key performance Indicators and key measurements identified for each of the three goals. o Key performance indicators are linked to the objectives under each goal and the actions that are in turn linked to elements included in the MHSA statute. o Key measurements identify what data elements and mechanisms will be used to evaluate key performance indicators for each goal. Pg. 16-20 20

21 Office of Statewide Health Planning and Development Key Measurements Review of available information to evaluate public mental health workforce supply o Licensing and Certification Data o Surveys to County Mental/Behavioral Health Departments o Surveys to Public Mental Health System Contractors o OSHPD Healthcare Workforce Clearinghouse Data Review of available information to evaluate public mental health workforce Demand o Profile of Users and Potential Users of Public Mental Health Services o Epidemiological Surveys o Prevalence Rates o Labor Substitution Review of information to evaluate state, regional, and local WET efforts outcomes o State, regional, and local WET programs evaluation o Regional and local reports evaluation (Such as: annual reports, and three-year reports) o Surveys of community based organizations. o Surveys of consumers of public mental health services o Surveys of stakeholders o Surveys of public mental health system workforce o Key informant interviews o Review of information to evaluate educational programs capacity o Surveys of training and education institutions in California Pg. 16-20 21

22 Office of Statewide Health Planning and Development Needs Assessment OSHPD engaged in a contract to conduct a large-scale analysis of Californias public mental health workforce needs. The complete Workforce Needs Assessment reports will be posted via the following link: http://www.oshpd.ca.gov/HWDD/WET.htm http://www.oshpd.ca.gov/HWDD/WET.htm Career Pathways Report In July 2013, OSHPD in partnership with the California Workforce Investment Board reconvened the Career Pathways Sub- Committee (Sub-Committee) to develop statewide career pathways, recommendations and action plans to strengthen the supply, distribution, and diversity of Californias Public Mental Health System (PMHS) Workforce. During Phase 3 the Sub- Committee met four times between July and September 2013, and provided recommendations on seven mental health professions* including: Alcohol and other Drug Use Counselors Clinical Psychologists Licensed Professional Clinical Counselors Marriage and Family Therapists Peer Support Specialists Psychiatric Mental Health Nurse Practitioners/Clinical Nurse Specialists Psychiatrists. The complete Career Pathways Phase 3 report can be found via the following link: http://www.oshpd.ca.gov/HWDD/pdfs/wet/Mental-Health-Career-Pathway-Report-2013.pdf http://www.oshpd.ca.gov/HWDD/pdfs/wet/Mental-Health-Career-Pathway-Report-2013.pdf * The Social Worker Pathway was developed during Phase 1 of the Sub-Committees engagement in 2012. Pg. 24-26 22

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27 Office of Statewide Health Planning and Development 26 Mental Health Profession Community Forum (n=14) Focus Group (n=13) Key Informant Interview (n=13) Survey (n=325) Total Psychiatrists 11531938 Consumer peer positions 14212037 Marriage and Family Therapist (MFT) 6202836 Psychiatric Mental Health Nurse Practitioner 11511330 Alcohol and Other Drug Abuse Counselors 7002330 Licensed Clinical Social Workers 5002429

28 Office of Statewide Health Planning and Development 27 Counties were asked to rate the effectiveness (impact) of each of the state- administered programs in placing or retaining personnel in hard-to-fill/retain positions State-Administered WET Program*n Average Rating % Rating the Program Somewhat or Very Effective MHLAP263.4292% Social Worker Stipend Program212.6767% MFT Stipend Program202.5570% PMHNP Stipend Program172.2453% Psychiatric Residency Program191.6826% Clinical Psychologist Stipend Program 171.5918% Song-Brown Program for Physician Assistants 121.080% Overall--2.32--

29 Office of Statewide Health Planning and Development Number of Mental Health Professionals Impacted by State WET Programs 21 Hard-to-fill/retain positions identified in 2008MHLAPStipend Psychiatric ResidencySong-Brown PATotal Participants Psychiatrist, General230-- 230 Licensed Clinical Social Worker2551,838*-- 2,093* Marriage and Family Therapist1259474-- 1,733 Licensed Supervising Clinician0-- 0 Psychiatrist, Child/Adolescent-- 10--10 Psychiatrist, Interdisciplinary Medicine Specialty -- 15--15 Registered Nurse12-- 12 CEO or Manager above Direct Supervisor3-- 3 Psychiatric or Family Nurse Practitioner892-- 100 Licensed Clinical Psychologist23283-- 306 Analysts, tech support, quality assurance0-- 0 Family Member Support Staff0-- Unknown Clinical Nurse Specialist1-- 1 Psychiatrist, Geriatric-- Unknown Consumer Support Staff4-- 4(Unknown) Positions not identified as hard to fill/retain in 2008 Physician Assistant0-- 1,382 Licensed Professional Clinical Counselor14 Bachelors Social Worker46 Associate Clinical Social Worker629 Other235 TOTAL SERVED:2,7192,687251,3826,813

30 Office of Statewide Health Planning and Development Proposed budget allocates $35 Million over four Years. Approximately 1,421 – 1,608 stipends over four years. Basis for Funding Decision: o Aligns with WIC section 5822(c),(f),(h),(i), and (j) o Builds upon existing program that has been rated as somewhat or very effective by Counties. o Identified as an effective recruitment strategy by stakeholders o Works to directly address professions of shortage, and hard to fill/hard to retain in the PMHS as identified by evaluation, Counties and other stakeholders. 29 Profession FundedFunding Amount Over 4 Years Social Worker$13.6 Million Marriage and Family Therapist$12.4 Million Psychiatric Nurse Practitioner$7.2 Million Clinical Psychologist$1.8 Million

31 Office of Statewide Health Planning and Development 30 Proposed budget allocates $40 Million over four Years. Approximately 4,200 Loan Repayments over four years. Basis for Funding Decision: o Aligns with WIC section 5822(b),(g), and (i). o Builds upon existing program that has been rated as most effective State WET Program with an average rating of 3.42 out of 4. o Identified as an effective strategy by stakeholders. o Works to address local shortage, and hard to fill/hard to retain professions in the PMHS as counties determine eligible professions based on their need. o Has a wide impact as all counties are allocated certain MHLAP funding based on a population based formula.

32 Office of Statewide Health Planning and Development 31 Proposed budget allocates $15 Million over 4 Years. Approximately 41 Psychiatric Residents and 250 Psychiatric Mental Health Nurse Practitioner slots will be partially funded over four years. Basis for Funding Decision: o Aligns with WIC section 5822(a),(g),(h),(i) and (j) o Builds upon existing program o Identified as an effective strategy by stakeholders o Works to address shortage of prescribing professionals of most need as identified by stakeholders and Counties which identified psychiatrist as highest need and indicated Psych NP as most used substitute. o Works to address low number of educational slots for identified professions Profession FundedFunding Amount Over 4 Years Psychiatrist$9 Million Psychiatric Mental Health Nurse Practitioner$6 Million

33 Office of Statewide Health Planning and Development 32 Proposed budget allocates $10 Million over four Years for activities that leads to consumer and family member employment (previously funded at $3.2 Million over four years) o OSHPD will convene an ad-hoc committee to determine what specific activities to fund with the allocated amount Basis for Funding Decision: o Aligns with WIC section 5822 (g) and (h) o Identified as an effective strategy by stakeholders o Works to address shortage of consumers and family members in the public mental health system workforce as identified by counties and stakeholders

34 Office of Statewide Health Planning and Development 33 Proposed budget allocates $9 Million over three Years for workforce, educating and training activities that meet regional needs Will fund 5 regional partnerships to engage in regional activities that meet priorities and framework of the WET Five-Year Plan Basis for Funding Decision: o Aligns with WIC section 5822 (d) o Identified as an effective strategy by stakeholders o Works to address regional PMH workforce needs o Has a wide impact as all counties can participate in regional partnership o Allocation set in Budget Act of 2012

35 Office of Statewide Health Planning and Development 34 Proposed budget allocates $3 Million over four Years for activities that leads to recruitment and retention of the Public Mental Health Workforce Basis for Funding Decision: o Aligns with WIC section 5822 (e)(g)(i) o Builds upon existing programs o Identified as an effective strategy by stakeholders o Has a wide impact as organizations from all counties can apply for program funding and can address shortage across professions o Strategies that have a broader impact to address current and future public mental health workforce demand Recruitment and Retention Strategy Funding over Four Years Career Awareness Mini-Grants$1 Million CalSEARCH$1 Million Retention$1 Million

36 Office of Statewide Health Planning and Development 35 Proposed budget allocates $2.74 Million over four Years for internal and external activities to evaluate workforce, education, and training efforts and determine outcomes and effectiveness in meeting aims of the WET Five-Year Plan and addressing Public Mental Health Workforce Needs. Basis for Funding Decision: o Aligns with WIC section 5820 (b)(c) o Identified as a critical strategy by stakeholders o Enables OSHPD to evaluate WET Five-Year Plan budget after 2 years to analyze and determine WET program funding for last two years. o Enables OSHPD to evaluate WET program effectiveness in 2019 at the completion of the WET Five-Year Plan 2014-2019.

37 Office of Statewide Health Planning and Development 36 ProfessionStipendLoan Assumption Educational Capacity Consumer and Family Member Employment Recruitment and Retention Regional Partnership Clinical Psychologist XXXX Consumers and Family Members XXXX Marriage and Family Therapist XXXX Psychiatrist XXXX Psych Nurse Practitioners XXXXX Social Worker XXXX Other Mental Health Professions XXX

38 Office of Statewide Health Planning and Development Lupe Alonzo-Diaz, Deputy Director Linda Onstad-Adkins, Chief Michael Wimberly, WET Manager Sergio Aguilar, WET Project Manager Office of Statewide Health Planning and Development 400 R Street, Suite 330 Sacramento, CA 95811-6213 (916) 326-3700 (tel) (916) 322-2588 (Fax) Lupe.Alonzo-Diaz@oshpd.ca.gov www.oshpd.ca.gov. 37


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