1. Lassen County Behavioral Health Barbara Pierson LCBH Director

2.  Located in rural Northeastern California on the eastern slope of Sierra Nevada Mountain range  County is 4,547 square miles (8 th largest in size)  Estimated population: 34,248 (US Census data)  Inmates at three area prisons make up 10,173 of the total population  Susanville is the only incorporated town (8,000- 10,000 residents)  Rest of county is made up of small communities ranging from 20-1,500 residents Lassen County

3.  Lassen has approximately 3,800 Veterans (one of the highest per capita in the state)  There are 1,448 children ages 0-5 (4.2% of population).  Population shift: number of children is shrinking while senior population continues to grow  Racial/Ethnic Make-up:  Caucasian: 82.6%  African American: 10.0%  Native Americans/Alaska Natives: 3.7%  Asian: 1.0%  Native Hawaiian/Pacific Islanders: 0.5%  Hispanic: 15.3% Lassen County

4.  While 79.6% of residents have graduated from high- school, only 10.7% have a bachelor’s degree  About 41.4% of Lassen County residents live below the 200% federal poverty limit  Unemployment rate holds steady at 17.1%  Lassen is one of the three lowest counties in California for economic well being Lassen County

5.  Majority of medical, social and behavioral health services are located in Susanville  County has established Family Resource Centers to serve three outlying areas  County is federally designated as a primary care, mental health and dental federal Health Professional Shortage Area (HPSA)  The is very limited public transportation throughout the county  Closest urban areas: Reno, Nevada which is 86 miles away or Redding, California which is 120 miles away Lassen County

6.  Alcohol and Drug and Mental Health Departments merged on July 1, 2012 to become Behavioral Health  5 locations – 2 Susanville, Herlong, Westwood, Bieber  New focus is client centered care (vs. system centered) using a holistic approach based on the 8 dimensions of wellness  Foundation is the Behavioral Health Home model – IHI chronic care model, Macoll, SAMHSA-HRSA  This model allows for better coordination of care since most clients have substance abuse, mental health issues, and physical conditions  Clients receive care through interdisciplinary teams Behavioral Health

7. Services will be delivered by interdisciplinary teams  All consumers will get to choose a care team.  Teams consist of: therapists, case managers, rehab specialists, AOD counselors, patient advocate, clerical.  Teams huddle every morning to discuss new clients, emergencies, expiring treatment plans, clients on the day’s schedule.  Care is easier to coordinate with case managers, rehab specialists, and AOD counselors working with the same therapist.  Teams assures the consumer that staff are familiar with their needs even if their provider is not there.  Consumers receive care within the team. They can change the people they receive services from but they stay within the team. Interdisciplinary Teams

8. Behavioral Health Department Effective July 1, 2012 Phase 1 Behavioral Health DirectorMedical Director Admin Support Supervisor Program Support Supervisor Admin/ Clerical Support Staff Programs QA/AI Grants Initiatives Prevention Training Work study Wraparound MHSA Support Nursing Staff Medical Services Team 1 Co-occurring Diversion Court Perinatal Floating Parenting Applied Behavioral Analyst Team 2Team 3 3 One Stop Teams Therapists Case Mgrs AOD Direct Services Clinical MH Supervisor Clinical MH Supervisor Clinical AOD Supervisor Clinical Supervision Team

9.  Co-dependency  Education (AOD)  Structured Outpatient  Promises  Day Rehab  Socialization  Relapse Prevention  Trauma  Anger  Co-occurring  Parenting  Adolescent life skills  Peer Support  WRAP  Self-esteem  Family  Medication  PTSD/Anxiety  Depression  DBT Group  Summer Youth Group  Friday Night Live  Skillstreaming© Groups

10. Common Holistic Approaches Integrated Care Planning Multiple Life Domain Focus Multidisciplinary Teams Natural and Peer Supports Team Facilitator/Designated Care Coordinator Motivational Interviewing Stages of Change After Care Planning (WRAP) Outcome Monitoring Adult System of Care Adults with multi-agency involvement at risk of placement, incarceration, or hospitalization Dual Diagnosis Adolescents and adults with co-occurring disorders Integrated WORKS Adult welfare-to- work clients with AOD and MH risk factors Family Solutions Wraparound Youth at risk of or returning from group home placement Children’s System of Care Children and adolescents at risk of out-of-home placement Full Service Partnerships SMI adults and children at risk of hospitalization, homelessness, or incarceration Integrated CPS Families with children at risk of out-of-home placement Health & Social Services Common Elements of Integrated Care March 2012

11. 8 dimensions of wellness

12. * Assuming that working in teams comes naturally to people * Eliminating silos and hierarchical thinking – physical and mental * Not allowing staff to fall back into old patterns * Change is difficult for most staff * Staff competencies * Learning what the other disciplines do and trusting them enough to delegate client responsibilities to * Staff turnover * Balancing between building a foundation and growing the program when opportunities arise Challenges

13. Things that worked or didn’t  Coffee hour every morning.  Taking inventory: We created a Dump/Keep/Don’t know list and went through it every morning at coffee hour and worked through each thing on the list.  Training staff – Netsmart, case manager meetings, webinars, time for people to meet.  EHR combining two ways of doing things – assessments, forms, progress notes, treatment plans.

14. -Staff competencies -Working within a larger bureaucracy – unions, personnel -Advisory boards -Limited local resources and their stability -Two sets of rules, regulations -Developing a common language Organizational Level issues

15. Thank you!