Mental Health Data Workbook and Training Ann Arneill-Py, PhD, Executive Officer CA Mental Health Planning Council Stephanie Oprendek, PhD, Senior Associate California Institute for Mental Health All Directors Meeting - December 10, 2009

CA Mental Health Planning Council Oversight of the public mental health system Oversight of the public mental health system Advocate for adults and older adults with SMI and children and youth with SED and their families Advocate for adults and older adults with SMI and children and youth with SED and their families Advise DMH, the Legislature, and local boards on mental health policies and priorities Advise DMH, the Legislature, and local boards on mental health policies and priorities Evaluate the performance of local mental health programs Evaluate the performance of local mental health programs Oversight of education and training component of MHSA Oversight of education and training component of MHSA

Mental Health Board Requirement Section , Welfare and Institutions Code Section , Welfare and Institutions Code –Review and comment on the county’s performance outcome data and communicate its findings to the California Mental Health Planning Council

Workbook Developed workbook to provide information to MHB/Cs on continuous quality improvement. Uses data on mental health services Developed workbook to provide information to MHB/Cs on continuous quality improvement. Uses data on mental health services –Penetration rates (identifies potential unmet need) –Retention rates (analyzed by gender, age, and race/ethnicity) (analyzed by gender, age, and race/ethnicity) Data were provided to all Mental Health Directors to review in June 2009 to review for accuracy Data were provided to all Mental Health Directors to review in June 2009 to review for accuracy Mandatory for MHB/Cs to complete workbook due to statutory mandate Mandatory for MHB/Cs to complete workbook due to statutory mandate Workbooks to be developed on an on-going 2-3 year cycle Workbooks to be developed on an on-going 2-3 year cycle

Workbook Table of Contents CHAPTER 1 CHAPTER 1 BACKGROUND BACKGROUND Engaging in Continuous Quality Improvement………………………… … Engaging in Continuous Quality Improvement………………………… … The Continuous Quality Improvement Process………………………… The Continuous Quality Improvement Process………………………… Access to Services (Penetration): Definition and Measurement…… …8 Access to Services (Penetration): Definition and Measurement…… …8 Service Retention: Definition and Measurement…………………… ….....…11 Service Retention: Definition and Measurement…………………… ….....…11 Using This Workbook to Examine Access (Penetration) and Using This Workbook to Examine Access (Penetration) and Retention Information Retention Information CHAPTER 2 CHAPTER 2 RACE/ETHNICITY: Access (Penetration) and Retention Information Analyzed by Race/Ethnicity RACE/ETHNICITY: Access (Penetration) and Retention Information Analyzed by Race/Ethnicity Examining and Interpreting the Access (Penetration) Charts…… ……...…15 Examining and Interpreting the Access (Penetration) Charts…… ……...…15 Examining and Interpreting the Retention Charts……………… …….…...….19 Potential Factors Associated with Access and Retention Differences Examining and Interpreting the Retention Charts……………… …….…...….19 Potential Factors Associated with Access and Retention Differences by Race/Ethnicity………………………………………………..…………......…… by Race/Ethnicity………………………………………………..…………......…… Questions to Guide the Continuous Quality Improvement Process… …...…25 Questions to Guide the Continuous Quality Improvement Process… …...…25 CHAPTER 3 CHAPTER 3 AGE: Access (Penetration) and Retention Information Analyzed by Age AGE: Access (Penetration) and Retention Information Analyzed by Age Examining and Interpreting the Access (Penetration) Charts………… … Examining and Interpreting the Access (Penetration) Charts………… … Examining and Interpreting the Retention Charts……………………… ….31 Potential Factors Associated with Access and Retention Differences Examining and Interpreting the Retention Charts……………………… ….31 Potential Factors Associated with Access and Retention Differences by Age……………………………………………………………………… …...…34 by Age……………………………………………………………………… …...…34 Questions to Guide the Continuous Quality Improvement Process… …...…37 Questions to Guide the Continuous Quality Improvement Process… …...…37 CHAPTER 4 CHAPTER 4 GENDER: Access (Penetration) and Retention Information Analyzed by Gender GENDER: Access (Penetration) and Retention Information Analyzed by Gender Examining and Interpreting the Access (Penetration) Charts………… …40 Examining and Interpreting the Access (Penetration) Charts………… …40 Examining and Interpreting the Retention Charts……………………… … Potential Factors Associated with Access and Retention Differences Examining and Interpreting the Retention Charts……………………… … Potential Factors Associated with Access and Retention Differences by Gender……………………………………………………………………….....……...46 by Gender……………………………………………………………………….....……...46 Questions to Guide the Continuous Quality Improvement Process… …....…49 Questions to Guide the Continuous Quality Improvement Process… …....…49 APPENDIX A: Statewide Access (Penetration) and Retention Charts………… APPENDIX A: Statewide Access (Penetration) and Retention Charts………… APPENDIX B: Access (Penetration) and Retention Data Tables…………… ….63 APPENDIX B: Access (Penetration) and Retention Data Tables…………… ….63 ENDNOTES / REFERENCES ENDNOTES / REFERENCES

One-Day Training CiMH will provide one-day trainings to MHB/Cs. CiMH will provide one-day trainings to MHB/Cs. Uses an inter-county gathering format: 2-4 neighboring counties. Uses an inter-county gathering format: 2-4 neighboring counties. Each county will receive the training within the next 18 months. Each county will receive the training within the next 18 months. Focus is on understanding CQI, data concepts, limitations of data, data interpretation. Focus is on understanding CQI, data concepts, limitations of data, data interpretation. Counties will explore their local penetration and retention data. Counties will explore their local penetration and retention data. During the training, CiMH will assist MHB/Cs in responding to questions posed by the CMHPC contained in the workbooks. During the training, CiMH will assist MHB/Cs in responding to questions posed by the CMHPC contained in the workbooks.

County Groupings for MHB/C Data Trainings Monterey*, San Benito, Santa Cruz Shasta*, Siskiyou, Tehama San Diego*, Imperial Del Norte, Humboldt, Trinity Madera, Merced, Stanislaus Butte, Colusa, Glenn, Sutter Fresno, Kings, Tulare Lassen, Modoc Kern, San Luis Obispo, Santa Barbara, Ventura Nevada, Plumas, Sierra, Yuba Los Angeles, Orange, Riverside, San Bernardino Lake, Mendocino, Sonoma Amador, El Dorado, Placer Sacramento, San Joaquin, Yolo Solano, Napa, Marin San Francisco, San Mateo, Santa Clara Alameda, Contra Costa Alpine, Inyo, Mono Calaveras, Tuolumne, Mariposa * Pilot County

Data Workbook Questions: Access/Penetration by RACE/ETHNICITY 1.What are your findings regarding access/penetration for mental health services by race/ethnicity? What racial/ethnic groups have higher access (penetration)? 2.What factors in your county account for differences in access (penetration) by race/ethnicity; e.g., transportation, geography, mental health literacy, stigma? 3.What barriers exist in your county to increasing the access (penetration) for mental health services for the identified underserved race/ethnic groups? 4.What is your understanding of what your county is doing to increase access (penetration) for mental health services by race/ethnicity; e.g., implementing the Mental Health Services Act and your county’s Cultural Competence Plan? 5.What recommendations do you have for increasing the access/penetration for mental health services for the identified underserved racial/ethnic groups in your county?

Data Workbook Questions: Service Retention by RACE/ETHNICITY 1.What are your findings regarding retention in mental health services by race/ethnicity? What racial/ethnic groups have higher retention in mental health services? 2.What factors in your county account for differences in retention by race/ethnicity; e.g., transportation, geography, mental health literacy, stigma? 3.What barriers exist in your county to increasing the retention in mental health services for the identified underserved racial/ethnic groups? 4.What is your understanding of what your county is doing to increase retention in mental health services by race/ethnicity; e.g., implementing the Mental Health Services Act and your county’s Cultural Competence Plan? 5.What recommendations do you have for increasing retention in mental health services for the identified underserved racial/ethnic groups in your county?

Contact Information Ann Arneill-Py, PhD, Executive Officer CA Mental Health Planning Council th Street, Room 420 Sacramento, CA (916) Stephanie Oprendek, PhD, Senior Associate California Institute for Mental Health th Street, 2nd Floor Sacramento, CA (916) ext. 155 (916) (cell)