Stars Behavioral Health Group INNs: Some considerations and examples from a provider’s perspective Karyn L. Dresser, Ph.D. Director, Research & Program Practices

Not all innovations yield constructive VALUE!

Invest more on those most in need Invest more where there are large volumes of unmet demand (e.g. “wait list” problems) Invest more where there are strong results, demonstrating effectiveness Invest more where there are large discrepancies in health outcomes COMPONENTS OF VALUE -- Public Health Policy Model VALUE Need Access Benefit Equity Cf., Gardner, W., Woltman, B.A., Currie, L. & E. Danseco, Eastern Ontario Research Institute

GETTING TO VALUE High Value Low Cost High Value High Cost Low Value Low Cost Low Value High Cost Cost Per Client (by a factor of 10) Value Ratings Allocations O IYRT CRT

Interagency Youth Resiliency Team (IYRT)  SBHG Valley Star INN from July 2012 to June 2015, part of wider San Bernardino community collaborative, incl. other providers  Goal = increase access to mental health care among system-involved children through: ­ Youth mentoring ­ Caregiver education and commitment ­ Trauma, grief & loss focus ­ Building community connections  Transformational? Child welfare elected to build the program into their array of service offerings

Interagency Youth Resiliency Team (IYRT) Cont’d  Building community capacity: 29 youth mentors, 9 caregiver mentors drawn from same community as those being served Workshops, special events, community networking  Improving caregiver understanding: More knowledgeable about the negative effect of grief, loss, and trauma on youth. 80% endorsement More likely to discuss difficult issues with youth. 100% endorsement  Supportive connections: Now know where I can get help for a personal or emotional problem. 92% endorsement Feel better about asking a friend or relative for help with a personal or emotional problem. 92% endorsement

Interagency Youth Resiliency Team (IYRT) Cont’d  Supportive connections (caregiver): Built a better attachment with youth. 80% endorsement  Enhancing behavioral and emotional health: Handle feelings of grief & loss better. 100% endorsement. Life has improved. 88% endorsement See Handout for More Program Results

Crisis Residential Treatment (CRT) The Stay  SBHG Valley Star INN opened March 2012, now approaching summative evaluation with intensifying efforts to establish post INN funding mechanisms.  14-bed behavioral health youth hostel located in the City of San Bernardino serving young adults ages 18 to 25 years who are experiencing a mental health crisis.  Rich programming focus on trauma, substance abuse and mental health recovery; wellness and independent life skills; and, community connectivity and stability.  Multidisciplinary staff include peer counselors, trained/licensed therapists, and medical personnel.

Crisis Residential Treatment (CRT) The Stay, Cont’d  As of end of last FY, 172 young adults served during 230 enrollments, average length of stay of 47 days.  Multiple areas of very good results include reduced high risk behaviors, improved functioning, personal strengths, and satisfied clients and community partners.  Almost one third (32%) had one or more readmissions. A continuing learning goal involves addressing client factors (e.g., bipolar diagnoses, very low GAF scores), program factors (e.g., clients leaving prematurely, against staff advice), and system of care factors (e.g., local emergency services and hospital referral processes and patterns) that drive readmissions.

Crisis Residential Treatment (CRT) The Stay, Cont’d See Handout for More Program Results

INN CHALLENGES FROM PROVIDER PERSPECTIVE  Front End Investments: Community can presents ideas, but submitting an idea does not mean it will advance to an RFP, nor are you guaranteed to win a contract for an idea you submitted!  Complexity: INNs typically require varied, innovative and sometimes idiosyncratic programming and evaluation methods  Sustainability: A strong partnership with the county is needed to address post INN funding sources  Contract & Community Risks: For example, a successful program might be taken over by a county department (SBHG expl.: IYRT); also, the community might become very engaged and invested only to have the program vanish once INN funding is over!