AFTERNOON. WE ARE GOING TO CALL
SUBCOMMITTEE ONE ON HEALTH TO
ORDER. WE CAN CALL ROLL. DOCTOR
WEBER HERE. MISS BONTA, MR.
PATTERSON. TODAY WE WILL BE
DOING AN OVERVIEW OF THE PUBLIC
HEALTH BEHAVIORAL HEALTH SYSTEM
HERE IN CALIFORNIA. WE ARE GOING
TO START WITH MR. WILL OWENS
FROM OUR LEGISLATIVE ANALYST'S
OFFICE FOR HIS PRESENTATION.
THANK YOU. GREAT. THANK YOU FOR
HAVING ME. CHAIR WEBER, AS YOU
SAY, MY NAME IS WILL OWENS WITH
THE LEGISLATIVE ANALYST'S OFFICE
. AND TODAY I'LL BE PRESENTING
SOME INFORMATION FOUND IN OUR
HANDOUT ON THE OVERVIEW OF THE
PUBLIC BEHAVIORAL HEALTH SYSTEM
IN CALIFORNIA. SO WE'RE GOING TO
BE DISCUSSING THREE PRIMARY
AREAS IN THIS PRESENTATION. THE
FIRST IS THE VARIOUS BEHAVIORAL
HEALTH DELIVERY SYSTEMS FOUND IN
THE STATE. THE SECOND IS BROADLY
THE CONTINUUM OF CARE FOR
BEHAVIORAL HEALTH SERVICES. AND
FINALLY, WE'LL DISCUSS SOME
RECENT BEHAVIORAL HEALTH
INITIATIVES AND HOW THEY
GENERALLY FIT WITHIN THE STATE'S
OVERALL BEHAVIORAL HEALTH
EFFORTS. SO ON THE FIRST PAGE OF
YOUR AGENDA OR THE THIRD PAGE OF
OUR HANDOUT, FIND A HIGH LEVEL
GRAPHIC WHICH SHOWS THE
DIFFERENT DELIVERY SYSTEMS
PROVIDED, THROUGHOUT THE
CONTINUUM AND THE DIFFERENT
SERVICES THAT CAN RANGE FROM
EVERYTHING FROM PREVENTION AND
WELLNESS SERVICES TO ACUTE CARE
SERVICES AND FACILITIES. SO THE
GRAPHIC ITSELF, AS YOU CAN SEE,
IS FAIRLY STRAIGHTFORWARD.
HOWEVER, THE BEHAVIORAL HEALTH
SYSTEM IN THE STATE IS QUITE
COMPLEX. YOU KNOW, THERE ARE
MULTIPLE DELIVERY SYSTEMS EACH
PROVIDING SERVICES OF VARYING
ACUITY, AND INDIVIDUALS WILL
OFTEN MOVE UP AND DOWN THE
CONTINUUM AS THEIR NEEDS CHANGE.
AND ACROSS DELIVERY SYSTEMS. SO
THIS FIGURE IS MEANT TO BE
ILLUSTRATIVE AND DOESN'T REALLY
CAPTURE A LOT OF THE OVERLAP
ING, LEVELS OF SERVICE THAT CAN
BE FOUND ACROSS DELIVERY SYSTEMS
IN BETWEEN LEVELS OF CARE WAS
MORE JUST TO GIVE YOU A BROAD
CONCEPTION OF THE SYSTEM AS A
WHOLE. SO FIRST, WITH OUR
DISCUSSION ON THE VARIOUS
DELIVERY SYSTEMS, PUBLIC HEALTH
OR RATHER PUBLICLY FUNDED
BEHAVIORAL HEALTH SERVICES ARE
TYPICALLY PROVIDED THROUGH
EITHER COUNTIES OR STATE FUNDED
MANAGED MEDI-CAL. SORRY MEDI-CAL
MANAGED CARE. SO COUNTIES ARE
PRIMARILY RESPONSIBLE FOR THE
FUNDING AND DELIVERY OF
BEHAVIORAL HEALTH SERVICES FOR
INDIVIDUALS ENROLLED IN
MEDI-CAL. WITH THE VERY HIGHEST
NEEDS, THE STATE ON THE OTHER
HAND, TYPICALLY FUNDS INDIVIDUAL
IS ENROLLED IN MEDI-CAL WITH
MILD TO MODERATE MENTAL HEALTH
NEEDS, AND THESE SERVICES ARE
DELIVERED PRIMARILY THROUGH
MANAGED CARE PLANS. SO WHILE NOT
NECESSARILY THE FOCUS OF THIS
HEARING, IN PARTICULAR, WE'D
JUST LIKE TO TOUCH ON THAT
BEHAVIORAL HEALTH CARE IS ALSO
PROVIDED IN OTHER PUBLICLY
FUNDED SETTINGS, PARTICULARLY IN
STATE RUN INSTITUTIONS,
SPECIFICALLY THE DEPARTMENT OF
STATE HOSPITALS AND THE
DEPARTMENT OF CORRECTIONS AND
REHABILITATION. ALSO BEHAVIORAL
HEALTH IS PROVIDED WITHIN THE
EDUCATIONAL SYSTEM, BOTH IN K-12
SCHOOLS AND INSTITUTIONS OF
HIGHER EDUCATION. OUR HANDOUT
DESCRIBES SOME OF THESE
INSTITUTIONAL SETTINGS AND
EDUCATION SETTINGS, AND SOME OF
THE SERVICES THEY PROVIDE, BUT I
WON'T BE TOUCHING THAT ON THEM
IN THIS PRESENTATION. SO NEXT I
WOULD LIKE TO TALK BRIEFLY ABOUT
THE CONTINUUM OF CARE. AS
MENTIONED, THIS RANGES FROM
PREVENTION AND WELLNESS SERVICES
ALL THE WAY TO ACUTE CARE
SERVICES AND FACILITIES. SO
BEHAVIORAL HEALTH SERVICES ARE
PROVIDED ON THIS CONTINUUM BASED
ON THE NEEDS OF AN INDIVIDUAL.
WE PROVIDED A HIGH LEVEL
BREAKOUT OF THESE TYPES OF
SERVICES. ON PAGE SEVEN OF OUR
HANDOUT. AND SO THE DIFFERENT
LEVELS OF THE CONTINUUM WE
DESCRIBE AREN'T ALL ENCOMPASSING
. FOR EXAMPLE, THERE ARE CRISIS
INTERVENTION SERVICES THAT YOU
COULD CONSIDER PREVENTION AS
WELL AS OUTPATIENT SERVICES OR
EVEN AN ACUTE CARE SERVICE KIND
OF CONTINUUM. SO THE ACTUAL
SERVICES PROVIDED RANGE ON THE
SPECTRUM. AND THERE'S QUITE A
BIT OF OVERLAP, I THINK, IN YOUR
AGENDA, THERE'S ALSO A CONTINUUM
OF CARE DEMONSTRATED BY THE
DEPARTMENT OF HEALTH CARE
SERVICES. AS YOU CAN SEE,
THERE'S SOME FLEXIBILITY THERE
WITH HOW YOU DEFINE SOME OF
THESE. BUT JUST TO GIVE YOU AN
OVERALL IMPRESSION OF LOWER
ACUITY AND HIGHER ACUITY. SO
PUTTING THIS ALL TOGETHER, I
WANT TO TOUCH ON BRIEFLY SOME OF
THE RECENT BEHAVIORAL HEALTH
INITIATIVES THAT HAVE HAPPENED
IN THE STATE. AND SO THERE HAVE
BEEN A NUMBER OF RECENT
BEHAVIORAL HEALTH INITIATIVES,
AND FOR EXAMPLE, THE CHILDREN
YOUTH BEHAVIORAL HEALTH
INITIATIVE, THIS IS SOMETHING
THAT CUTS ACROSS MULTIPLE
DEPARTMENTS AND INCLUDES
MULTIPLE SERVICE DELIVERY
SYSTEMS. THIS CAN MAKE IT
DIFFICULT SOMETIMES, MAYBE FOR
THE LEGISLATURE TO EVALUATE THE
OUTCOMES AND TO MAKE FUTURE
BUDGETARY DECISIONS, AS A LOT OF
THESE PROGRAMS TOUCH ON SO MANY
DIFFERENT PARTS OF THIS
CONTINUUM. SO IN OUR HANDOUT, WE
DISCUSS BROADLY THE DIFFERENT
AREAS OF THE BEHAVIORAL HEALTH
SYSTEM THAT ARE IMPACTED BY SOME
OF THESE INITIATIVES FROM
BEHAVIORAL HEALTH SERVICES FOR
CHILDREN, YOUTH BEHAVIORAL
HEALTH SERVICES FOR ADULTS,
BEHAVIORAL HEALTH
INFRASTRUCTURE, AND BEHAVIORAL
HEALTH WORKFORCE, WHICH I KNOW
WAS A SUBJECT FOR ANOTHER
HEARING. BUT ALL OF THESE THINGS
KIND OF TIE TOGETHER. SO TO KIND
OF GIVE A HIGH LEVEL, TAKEAWAY
OF A NUMBER OF THE RECENT
BEHAVIORAL HEALTH INITIATIVES
AND HOW THEY'VE IMPACTED THE
SYSTEM, WE KIND OF HAVE TWO MAIN
POINTS. THE FIRST IS THAT MANY
OF THE INITIATIVES INCLUDE
EFFORTS TO INCREASE CAPACITY,
BROADLY ACROSS THE BEHAVIORAL
HEALTH SYSTEM. THESE INCLUDE
EFFORTS TO IMPROVE BEHAVIORAL
HEALTH INFRASTRUCTURE, TO
INCREASE BED CAPACITY, THINGS OF
THAT NATURE, AS WELL AS IMPROVE
AND EXPAND THE WORKFORCE, AS
WELL AS IMPROVE THE PIPELINE OF
BEHAVIORAL HEALTH WORKERS. SO
MUCH OF THE FUNDING FOR THE
BEHAVIORAL HEALTH SYSTEM IN
RECENT YEARS HAS BEEN LIMITED.
OR ONE TIME FUNDING AND GIVEN
THAT THE NATURE OF THESE FUNDS
WERE ONE TIME, USING THEM TO
EFFORTS TO INCREASE CAPACITY
RATHER THAN FUND ONGOING
SERVICES, WE OUR OFFICE HAS
GENERALLY FOUND REASONABLE, THE
SECOND KIND OF OVERARCHING,
MESSAGE, THAT OR THEME THAT
WE'VE KIND OF FOUND WITH THESE
RECENT BEHAVIORAL HEALTH
INITIATIVES IS THAT THERE'S BEEN
A LARGE FOCUS ON CONNECTING NEW
OR UNDERSERVED POPULATIONS WITH
SERVICES IN NEW WAYS. SO, FOR
EXAMPLE, EFFORTS LIKE MOBILE
CRISIS SERVICES, THESE EFFORTS
NOT ONLY CONNECT TO INDIVIDUALS
WHO MAY HAVE BEEN LACKING ACCESS
TO BEHAVIORAL HEALTH SERVICES,
BUT ALSO PROVIDES THESE SERVICES
IN A NEW WAY IN THE COMMUNITY
AND NOT IN TRADITIONAL. MAYBE
OFFICE OR DOCTOR'S SETTINGS, IN
ADDITION, INITIATIVES LIKE THE
CARE ACT, CREATE A NEW PROCESS
BY WHICH INDIVIDUALS MAY ACCESS
BEHAVIORAL HEALTH AND WRAPAROUND
SERVICES, AS I DISCUSSED, THESE
ARE JUST SOME OF THE MAIN
TAKEAWAYS. AND IN OUR HANDOUT WE
GO KIND OF BREAKING OUT THE
VARIOUS INITIATIVES. THESE
AREN'T ALL ENCOMPASSING. THERE'S
A LOT OF COMPONENTS OF A LOT OF
THESE THAT WE DON'T TOUCH ON.
BUT THESE ARE JUST TO GIVE YOU A
BROAD OVERVIEW OF THE DIFFERENT
WAYS THAT THESE INITIATIVES HAVE
, IMPACTED NOT ONLY THE
BEHAVIORAL HEALTH SYSTEM, BUT
KIND OF HOW THEY FIT ALONG THE
CONTINUUM AS WELL, WITH THAT,
THAT CONCLUDES MY PRESENTATION
AND AVAILABLE FOR QUESTIONS.
THANK YOU SO MUCH FOR YOUR
PRESENTATION, ONE OF THE THINGS
THAT YOU JUST TOUCHED UPON ON,
WAS THAT WHAT WE'RE TRYING TO DO
HERE AT THE STATE LEVEL IS VERY
DIVERSE AND TOUCHES A LOT OF
DIFFERENT AREAS. WAS AND, THAT,
OF COURSE, IS IMPORTANT BECAUSE
BEHAVIORAL HEALTH SHOWS UP IN A
LOT OF DIFFERENT AREAS. BUT I
GUESS MY QUESTION TO YOU IS, DO
YOU WHEN YOU'RE ANALYZING AND
WHEN YOU'RE LOOKING AT THE
PROGRAMS AND WHERE THEY HAVE
BEEN PLACED, DO YOU FEEL LIKE
THEY ARE TOO SPREAD OUT AND TOO
BROAD THAT IT'S HARD FOR THAT?
IT WOULD BE HARD FOR US TO
REALLY DETERMINE THE
EFFECTIVENESS BECAUSE WE'RE
TOUCHING SO MANY DIFFERENT AREAS
. I THINK THAT SPEAKS A LOT TO
MAYBE, OUTCOME EVALUATION FOR A
LOT OF THESE PROGRAMS. RIGHT. I
THINK, AS YOU SAY, A LOT OF
THESE KIND OF SPAN ACROSS THE
SPECTRUM, NOT ONLY IN SERVICE
DELIVERY, BUT IN INFRASTRUCTURE,
BED CREATION AND WORKFORCE. I
THINK WHEN YOU ARE EVALUATING
SOMETHING LIKE BEHAVIORAL
HEALTH, BROADLY, IT'S A LITTLE
HARD TO CONCEPTUALIZE WHAT THAT
MEANS IS, YOU KNOW, WHAT IS GOOD
BEHAVIORAL HEALTH, HOW IS THE
STATE MAKING IMPROVEMENTS UPON
IT, I THINK THE WAY WE APPROACH
IT WHEN EVALUATING IS WE LOOK AT
MAYBE THE PROGRAMS A LITTLE MORE
DISCRETELY. AND WHAT ARE THE
OUTCOMES FOR A SPECIFIC PROGRAM,
ARE THE BEDS THAT WERE PROJECTED
TO BE CREATED WITH A NEW
PROPOSAL? ARE THEY BEING
CREATED, IS THE MONEY GETTING
SPENT? IS IT BEING USED? AND
THAT'S KIND OF THE THROUGH KIND
OF BUDGETARY MEANS. LIKE THAT IS
KIND OF THE WAY THAT WE EVALUATE
THESE THINGS. BUT I THINK A
BROADER QUESTION ON, ARE ALL
THESE THINGS TOGETHER IMPROVING
THE BEHAVIORAL HEALTH OUTCOMES
IN THE STATE IS A VERY VALID
QUESTION, AND SOMETHING THE
LEGISLATURE SHOULD, REALLY
EVALUATE WHEN LOOKING AT THESE
PROPOSALS. THANK YOU. AND I
THINK ALONG THOSE LINES, BECAUSE
THE STATE IS INVESTING A LOT OF
MONEY, AS THEY SHOULD IN THE
BEHAVIORAL HEALTH SPACE. BUT
THERE HAVE BEEN TIMES WHEN THE
STATE HAS INVESTED A LOT OF
MONEY IN A VARIETY OF DIFFERENT
THINGS, AND WE REALLY HAVEN'T
SEEN THE OUTCOMES THAT THAT
WE'RE HOPING FOR. WHAT ADVICE
WOULD YOU GIVE TO THE
LEGISLATURE AS FAR AS OVERSIGHT?
HOW OFTEN SHOULD WE BE ASKING
FOR THE DATA TO SHOW WHETHER OR
NOT SOME OF THESE PROGRAMS THAT
WE'RE FUNDING AND ALL OF THESE
DIFFERENT AREAS IS ACTUALLY,
IMPROVING THING. OUR PATIENTS,
OUR RESIDENTS THAT HAVE
BEHAVIORAL HEALTH ISSUES. YEAH.
SO, I'LL SAY SPECIFICALLY IN
RECENT YEARS, AS, AS I
MENTIONED, THERE'S BEEN A FAIRLY
LARGE INVESTMENT IN BEHAVIORAL
HEALTH SERVICES. A LOT OF THIS
ONE TIME, OR LIMITED TIME
FUNDING. SO I THINK ESPECIALLY
WHEN YOU LOOK AT THINGS THAT
HAVE TO DO WITH WORKFORCE, WITH
HIRING, WITH INFRASTRUCTURE,
BUILDING THESE THINGS CAN TAKE
SOME TIME TO KIND OF WORK
THROUGH THE SYSTEM. I THINK, THE
LEGISLATURE SHOULD, YOU KNOW,
ALWAYS TAKE THE OPPORTUNITY TO
ASK AND WORK WITH THE
ADMINISTRATION REGARDING
SPECIFIC OUTCOMES OF FUNDING,
REGARDING HOW THE FUNDING IS
BEING SPENT, IS IT BEING SPENT
IN A TIMELY WAY, THESE ARE ALL
THINGS THAT WE TRY TO LOOK AT
AND EVALUATE THROUGHOUT THE
BUDGET PROCESS AND EVEN OUTSIDE
OF THE BUDGET SEASON, IS KIND OF
EVALUATING THESE PROGRAMS ON A
BUDGETARY BASIS. AND ANY
OPPORTUNITY THAT THE LEGISLATURE
HAS A PARTICULAR INTEREST IN A
SPECIFIC INITIATIVE OR SPECIFIC
PART OF INITIATIVE, I THINK, IS
AN OPPORTUNITY TO PERFORM
OVERSIGHT AND TO ENSURE THAT IT
IS, MEETING LEGISLATIVE
EXPECTATIONS AND OBJECTIVE.
THANK YOU FOR YOUR PRESENTATION.
I DO THINK THAT FROM A
LEGISLATIVE STANDPOINT, WE ARE
GOING TO HAVE TO DO THINGS A
LITTLE DIFFERENT, AND I THINK
ONE OF THE THINGS THAT WE'VE
ADDRESSED HERE ON THIS COMMITTEE
DEALS WITH THE LOAN REPAYMENT
PROGRAM FOR THE PSYCHIATRY
DIVISION. SO AS WE TALK ABOUT
INCREASING WORKFORCE, AND I
NOTICED THAT WAS ALSO MENTIONED
ABOUT LOAN REPAYMENTS, WE
ALLOCATED THOSE FUNDINGS AND YET
IT WAS NEVER ACTUALLY
IMPLEMENTED. SO, I DO HAVE
CONCERNS BECAUSE IT IS SO BROAD,
AT THIS POINT, WHETHER OR NOT
WE'LL BE ABLE TO REALLY, TRULY
WRAP OUR ARMS AROUND EVERYTHING
TO MAKE SURE THAT ALL OF THESE
THINGS THAT WE'RE FUNDING AND
WE'RE TRYING TO DO ARE ACTUALLY
WORKING, AND IF NOT, WHERE IS
THE AREA THAT WE NEED TO TINKER,
BUT IT IS DEFINITELY SOMETHING
THAT WE AT THE LEGISLATURE NEED
TO DO A BETTER JOB OF, AND I'M
SURE WE WILL IN THE UPCOMING
FUTURE. SO WITH THAT, I WANT TO
THANK YOU SO MUCH FOR THIS
OVERVIEW, WE ARE GOING TO NOW
TURN TO OUR PANEL. AND I'M GOING
TO ASK TOBY EWIG EWING. EWING
FROM THE MENTAL HEALTH SERVICES
OVERSIGHT AND ACCOUNTABILITY
COMMISSION, MICHELLE CABRERA
FROM THE COUNTY BEHAVIORAL
HEALTH DIRECTORS ASSOCIATION OF
CALIFORNIA, AND DOCTOR ALEXIS
SEGUIN FROM THE CALIFORNIA
ASSOCIATION OF PSYCHIATRISTS.
THANK YOU. AND YOU CAN BEGIN.
THANK YOU VERY MUCH, TOBY EWING,
ON BEHALF OF THE STATE'S MENTAL
HEALTH COMMISSION, REALLY
APPRECIATE THE CHANCE TO JOIN
YOU AND THAT YOU'RE FOCUSING ON
BEHAVIORAL HEALTH IN THIS WAY,
THIS HIGH LEVEL OVERVIEW, AS YOU
STATED EARLIER, THE STATE HAS
MADE SIGNIFICANT INVESTMENTS,
YET WE'VE ALSO STRUGGLED TO
FIGURE OUT HOW WE CAN MOST
APPROPRIATELY UNDERSTAND THE
IMPACT THAT THOSE INVESTMENTS
HAVE HAD AND MORE IMPORTANTLY,
UNDERSTAND THE MECHANISMS THAT
THOSE INVESTMENTS ARE SUPPORTING
THAT LEAD TO THE OUTCOMES THAT
YOU'RE THAT YOU'RE LOOKING FOR.
YEAH, WE LOOK AT WHAT HAPPENS
AROUND CALIFORNIA AND AROUND THE
COUNTRY AND IN OTHER COUNTRIES.
AND THE GOOD NEWS IS THAT WE'VE
MADE SUBSTANTIAL PROGRESS IN
PREVENTION, IN EARLY
INTERVENTION IN TAILORING CARE
TO BE RESPONSIVE TO NEEDS IN
UNDERSTANDING HOW WE CAN BETTER
DO PEER AND COMMUNITY
EMPOWERMENT, PEER AND COMMUNITY
ENGAGEMENT TO REALLY SHAPE THE
PROGRAMS AND POLICIES THAT ARE
IMPACTING THE LIVES OF THE
PEOPLE WE'RE TRYING TO SERVE.
WE'RE LEVERAGING SCHOOLS, THE
WORKPLACE, THE TALENTS AND
CAPACITIES OF COMMUNITY BASED
ORGANIZATIONS. THERE'S BEEN
HUNDREDS OF MILLIONS OF DOLLARS
IN INNOVATION, INVESTMENT ACROSS
THE STATE. THE STATE OF
CALIFORNIA IS FAR AHEAD IN TERMS
OF THE PROGRESS WE'VE MADE TO
MEET NEEDS. YET AT THE SAME TIME
, WE HAVE JUST PROFOUND
CHALLENGES. WE'RE OFTEN NOT
OUTCOME BASED, PER YOUR
COMMENTS, TOO MANY PEOPLE
CONTINUE TO BE TO MAKE CONTACT
WITH BEHAVIORAL HEALTH SERVICES
THROUGH LAW ENFORCEMENT OR JAIL
OR PRISON OR LOCKED SETTINGS, WE
HAVE PROFOUND DELAYS IN ACCESS
TO CARE. WE HAVE OVERRELIANCE ON
DEEP END CARE BECAUSE OUR
SYSTEMS AND STRATEGIES TO DO THE
EARLY INTERVENTION OFTEN ARE NOT
AS ROBUST AS THEY NEED TO BE. WE
ALSO DON'T HAVE SUFFICIENT
OPPORTUNITIES TO LEARN AND SCALE
AROUND BEST PRACTICES. WE SEE
VERY STRONG PATTERNS OF LEARNING
AND SCALING OF RESEARCH AND
INVESTMENT IN INCENTIVE
FINANCING AND OTHER ASPECTS OF
HEALTH CARE AND EITHER OTHER AND
OTHER AREAS OF PUBLIC POLICY.
BUT THE BEHAVIORAL HEALTH SYSTEM
IS NEW TO THOSE STRATEGIES ARE
NEW TO THE BEHAVIORAL HEALTH
SYSTEM, IN THE LAST FIVE YEARS,
WE'VE SEEN JUST TREMENDOUS
PROGRESS AND LEADERSHIP FROM OUR
COUNTY BEHAVIORAL HEALTH
PARTNERS IN THAT AREA. BUT THE
POTENTIAL TO ACTUALLY EXPAND
THOSE OPPORTUNITIES IS
TREMENDOUS FOR THIS STATE.
FUNDAMENTALLY, PUBLIC
UNDERSTANDING OF OUR BEHAVIORAL
HEALTH SYSTEM IS CHALLENGING. I
RECEIVE PHONE CALLS OFTEN IN THE
MIDDLE OF THE NIGHT FROM PEOPLE
WHO DON'T EVEN KNOW WHERE TO
TURN, AND THAT IS HIGHLY UNUSUAL
IN OTHER ASPECTS OF HEALTH CARE,
WHERE PEOPLE HAVE A REALLY CLEAR
SENSE OF THE WAY THE SYSTEM IS
ORGANIZED, HOW THEY ACCESS
ACCESS THAT SYSTEM, HOW IT'S
BEING PAID FOR, AND BEHAVIORAL
HEALTH SYSTEM, THAT IS A HUGE
BARRIER. STIGMA CERTAINLY IS A
CONTINUING CHALLENGE AND
DISPARITY IS MUST BE AN AREA OF
FOCUS AND AN ENDURING
COMMITMENT, SOMETHING THAT THE
STATE HAS MADE SOME PROGRESS ON.
BUT IT CONTINUES TO BE VERY
DIFFICULT. WE REALLY MUST DO
MORE TO ENGAGE EARLY ON TO
REDUCE THE DEEP END UTILIZATION
OF DEEP END SERVICES, BUT ALSO
TO REDUCE THE COSTS ASSOCIATED
WITH THAT LEVEL OF CARE. THE
STATE HAS AN OPPORTUNITY TO
REDESIGN AND RETHINK, TO REALLY
PULL RESOURCES OUT OF DEEP END
CARE AND MAKE THEM AVAILABLE
THROUGH MORE UPSTREAM, MUCH MORE
COST EFFECTIVE STRATEGIES,
AGAIN, I'D SAY, YOU KNOW,
CALIFORNIA IS LEADING THE
COUNTRY. WE HAVE WE'RE VERY
OPTIMISTIC ABOUT OPPORTUNITIES
TO REALLY DO THIS WELL. BUT AS
WE CAN SEE FROM THE NEWS, EVERY
DAY, FROM WHAT WE SEE WHEN WE
WALK DOWN THE STREETS, IN MOST
COMMUNITIES IN CALIFORNIA, WE
HAVE A LOT OF WORK TO DO. THANK
FOR THE CHANCE TO JOIN YOU.
HAPPY TO ANSWER ANY QUESTIONS
YOU HAVE. THANK YOU. GOOD
AFTERNOON, MADAM CHAIR. MICHELLE
CABRERA WITH THE COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION OF CALIFORNIA. AND
TODAY I'M GOING TO SPEAK TO THE
BEHAVIORAL HEALTH CONTINUUM AND
WE'VE PREPARED A ONE PAGE
HANDOUT TO HELP PROVIDE A VISUAL
AID FOR MY TALKING POINTS. AND
I'M SURE YOU'LL HEAR, QUITE A
NUMBER OF CONSISTENT THEMES
ACROSS THE VARIOUS SPEAKERS
TODAY. WE KNOW THAT OUR
COMMUNITIES HAVE FACED INCREASED
NEED FOR BEHAVIORAL HEALTH
SERVICES IN THIS PANDEMIC ERA,
ALONG WITH CLIMATE CHANGE,
POLITICAL UNREST, SOCIAL MEDIA,
AND WITH THE ARRIVAL OF GOVERNOR
NEWSOM'S ADMINISTRATION, THÀNH
CALIFORNIA HAS EMBARKED ON A
SIGNIFICANT NUMBER OF REFORMS
FOCUSED ALONG MULTIPLE DELIVERY
SYSTEMS, INCLUDING COMMERCIAL
PLAN PARITY LAWS AND
ENFORCEMENT. NEW INVESTMENTS IN
RATES FOR MEDI-CAL MANAGED CARE
PLANS, MILD TO MODERATE BENEFIT,
THE PAYER AGNOSTIC SIB HIGH
SCHOOL BASED FEE SCHEDULE AND
VIRTUAL SERVICES PLATFORM IN
SCHOOLS, THE ROLLOUT OF OUR 988
CRISIS HOTLINE AND NUMEROUS
OTHER MAJOR REFORMS IN THE
COUNTY. BEHAVIORAL HEALTH,
SAFETY NET, INCLUDING BUT NOT
LIMITED TO PAYMENT AND BILLING
SYSTEM REFORMS, AS WELL AS AN
OVERHAUL OF OUR MENTAL HEALTH
SERVICES ACT AND LPS AND
VOLUNTARY CARE LAWS. THESE
THINGS ARE HAPPENING VIRTUALLY
SIMULTANEOUSLY. I WILL NOTE THAT
THE VISION OF THE CONTINUUM THAT
I SHARE WITH YOU TODAY, ONE THAT
STARTS AT PREVENTION AND MOVES
ALL THE WAY THROUGH OUTPATIENT,
INTENSIVE, OUTPATIENT, ACUTE,
AND THE HIGHEST LEVELS OF
INVOLUNTARY TREATMENT IN STATE
HOSPITALS ARE QUITE UNIQUE TO
COUNTY BEHAVIORAL HEALTH. NO
OTHER BEHAVIORAL HEALTH SYSTEM
STRETCHES SO FAR TO MEET THE
COMMUNITY NEEDS SO
COMPREHENSIVELY. AND ALTHOUGH
COUNTIES DO SERVE THE WHOLE
COMMUNITY TO THE EXTENT THAT
THEY HAVE RESOURCES, AS OUR
PRIMARY OBLIGATION STANDS WITH
THE MEDI-CAL POPULATION, THÀNH
WITHIN MEDI-CAL COUNTIES ARE
MANAGING AN ENTITLEMENT, MEANING
THAT WE HAVE TO SERVE ANY
MEDI-CAL BENEFICIARY WITH THE
COMPLEX NEED FOR SPECIALTY
MENTAL HEALTH OR SUBSTANCE USE
DISORDER SERVICES. THE
BEHAVIORAL HEALTH CONTINUUM IS
ALSO INCLUSIVE OF A RANGE OF
PROGRAMS AND SERVICES THAT ARE
TODAY NOT ELIGIBLE FOR ANY SORT
OF INSURANCE REIMBURSEMENT. FOR
EXAMPLE, PREVENTION IS LARGELY
NOT FUNDED BY ANY INSURANCE
PAYER, AND UNTIL MEDI-CAL
STARTED PAYING FOR SHORT TERME
HOUSING AND SUPPORTS NO PAYER
COVERED HOUSING IN A MEDICAL
MODEL, WHAT IS OR IS NOT COVERED
VARIES TREMENDOUSLY BY PAYER AS
WELL. BUT THOSE GAPS ARE
SIGNIFICANT IN EITHER CREATING
OR EXACERBATING CONDITIONS AS
INTO PREVENTABLE DISABILITY AND
PREMATURE PREVENTABLE MORTALITY
OUTCOMES. IN FACT, BEHAVIORAL
HEALTH CONDITIONS ARE THE
WORLD'S LEADING CAUSE OF
DISABILITY. AND THIS IS WHY IN
OUR DISCUSSION OF THE CONTINUUM,
WE'RE INCLUSIVE OF INDIVIDUALS
WITH COMMERCIAL INSURANCE AS THE
UNDERINSURANCE THAT THEY
EXPERIENCE IS AND CAN BE A
SIGNIFICANT DRIVER OF DISEASE
OUTCOMES, AS WELL AS RECOVERY
FOR TOO LONG, COMMERCIAL
INSURERS HAVE TREATED BEHAVIORAL
HEALTH CONDITIONS ALMOST LIKE AN
ELECTIVE, FORCING THEIR
BENEFICIARIES TO PAY OUT OF
POCKET IF THEY CAN AFFORD TO,
RATHER THAN PROVIDING READY
ACCESS TO THE VERY BENEFITS THEY
PAY FOR IN FACT, ONE STUDY
SHOWED THAT COMMERCIALLY INSURED
CONSUMERS PAY ARE SIX TIMES MORE
LIKELY TO PAY OUT OF POCKET TO
MEET THEIR BEHAVIORAL HEALTH
NEEDS THAN FOR OTHER PHYSICAL
HEALTH CONDITIONS. IT ALSO MEANS
THAT FOR THE VAST MAJORITY OF
CONSUMERS WHO LACK THE FINANCIAL
RESOURCES OR WHEREWITHAL TO
NAVIGATE ACCESSING THE
APPROPRIATE CARE ON THEIR OWN,
THEIR LIVES CAN RAPIDLY SPIRAL
TO THE POINT OF HITTING
EMERGENCY DEPARTMENTS AND THE
CRIMINAL JUSTICE SYSTEM, OR
WORSE. IN MEDI-CAL, MANY OF THE
ESSENTIAL FUNCTIONS THAT COUNTY
BEHAVIORAL HEALTH SERVICES
PROVIDES CANNOT BE FUNDED EVEN
THROUGH MEDI-CAL. WHILE
CALIFORNIA IS PURSUING AN 1115
WAIVER TO WAIVE THE RULE THAT
MEDICAID WILL NOT TYPICALLY PAY
FOR RESIDENTIAL OR INPATIENT
MENTAL HEALTH TREATMENT IN
FACILITIES LARGER THAN 16 BEDS,
THIS LAW RECOGNIZES THAT LARGER
SETTINGS HISTORICALLY WERE NOT
PLACES OF HEALING. IT DATES BACK
TO THE ESTABLISHMENT OF MEDICAID
AND WAS MEANT TO REINFORCE THE
DEINSTITUTIONALIZATION LAWS
SIGNED BY THEN PRESIDENT
KENNEDY. PROP ONE PROVIDES THE
RESOURCES FOR US TO PURSUE
HOUSING AND FACILITIES NEEDED TO
SHIFT, BUT IT SHIFTS FUNDS FROM
MENTAL HEALTH TO TRY AND ADDRESS
THOSE HOUSING AND SUBSTANCE USE
DISORDER NEEDS. THE NET IMPACT
ON OUR SYSTEM IS THAT THE MOST
ACUTE LEVELS OF CARE FOR
MEDI-CAL ARE LARGELY NOT COVERED
BY THE STATE OR THE FEDERAL
GOVERNMENT'S WAIVERS, LIKE THE
DMC ÓRDENES FOR SUBSTANCE USE
AND THE PENDING CONNECT WAIVER
UNDER MEDI-CAL FOR MENTAL HEALTH
SERVICES MAY ALLOW US TO PROVIDE
LIMITED FEDERAL FINANCIAL
PARTICIPATION. BUT THOSE
INITIATIVES BOTH COME WITH MANY
STRINGS ATTACHED. SIMILARLY,
OUTREACH AND ENGAGEMENT
SERVICES, ESPECIALLY THOSE
NEEDED TO REACH PEOPLE WHO ARE
UNHOUSED, ARE ESSENTIAL IN
IDENTIFYING INDIVIDUALS WHO NEED
OUR SERVICES AND BRINGING THEM
IN. BUT THAT OUTREACH AND
ENGAGEMENT IS NOT COVERED UNDER
MEDICAID. THE REASON THE
CONTINUUM OF CARE MATTERS SO
MUCH IS THAT WE KNOW THAT WHEN
INDIVIDUALS HAVE AWARENESS OF
WHAT BEHAVIORAL HEALTH
CONDITIONS ARE TO THE POINT OF
OUR ANTI-STIGMA EFFORTS. AND
THANK YOU SO MUCH FOR YOUR BILL
ON THAT TOPIC, CHAIR, AND HOW TO
ADDRESS THEM. THEY CAN ADVOCATE
FOR THEMSELVES AND THEIR LOVED
ONES TO GET CARE EARLY WHEN
OUTPATIENT AND SPECIALTY CARE
SERVICES ARE READILY AVAILABLE,
INDIVIDUALS CAN MOST OFTEN HEAL,
SAVING INDIVIDUALS, THEIR
EMPLOYERS, AND THE GOVERNMENT.
POTENTIALLY HUNDREDS OF MILLIONS
OF DOLLARS. ONE STUDY FOUND THAT
INDIVIDUALS WITH BEHAVIORAL
HEALTH CONDITIONS ARE AMONG THE
MEDICAL SYSTEM'S MOST COSTLY.
BUT MORE IMPORTANTLY, WE CAN
AVOID THE UNNECESSARY SUFFERING
THAT RIPPLES THROUGH FAMILIES
AND COMMUNITIES QUITE LITERALLY,
INTENDING TO ACCESS THE
APPROPRIATE, MEDICALLY NECESSARY
CARE THAT'S NECESSARY TO SAVE
THEIR LIVES. IN ORDER TO DO THIS
WORK, WE ALL NEED A ROBUST
CONTINUUM THAT STARTS AT
PREVENTION AND WORKS AS HARD AS
POSSIBLE TO ENSURE ACCESS TO
COMPREHENSIVE QUALITY,
OUTPATIENT AND EARLY
INTERVENTION FOR SPECIALTY CARE
NEEDS. THIS IS THE MISSION OF
COUNTY BEHAVIORAL HEALTH. WE SEE
CONSUMERS ACHIEVE RECOVERY EVERY
SINGLE DAY AND VERY MUCH
APPRECIATE THE OPPORTUNITY TO
DISCUSS THIS IMPORTANT TOPIC
WITH YOU TODAY. I'M ALSO HAPPY
TO TAKE ANY QUESTIONS. THANK YOU
. HI, I'M ALEXIS SAGAN, I'M THE
REPRESENTING THE CALIFORNIA
STATE ASSOCIATION OF
PSYCHIATRISTS. THANK YOU, DOCTOR
WEBER, FOR HAVING HAVING US
HERE, SO I REPRESENT OVER THREE,
AROUND 3000 PSYCHIATRISTS WITHIN
THE STATE OF CALIFORNIA, AND I
PERSONALLY AM A PHYSICIAN AT UC
IRVINE MEDICAL CENTER, WHICH IS
A SAFETY NET HOSPITAL. WE WORK
PRIMARILY WITH MEDI-CAL
POPULATION, AND I WORK ON THEIR
INPATIENT UNITS AS WELL AS DO
SOME OUTPATIENT, YOU KNOW, ONE
OF THE THINGS THAT'S BEEN SO,
YOU KNOW, WE'VE WE'VE SEEN SO
PROFOUNDLY IN THE LAST FEW
YEARS, IS THAT THE MOST TRAINED
PSYCHIATRISTS, THE INDIVIDUALS
WITH THE MOST TRAINING FOR
MENTAL HEALTH TREATMENT, ARE
ACTUALLY TREATING THE LEAST ILL.
YOU KNOW, THE PEOPLE WHO ARE
NPS, PAS ARE NOW GOING THEY'RE
GOING TO THE PLACES WHERE
BASICALLY PSYCHIATRISTS AREN'T
FINANCIALLY ENTICED TO GO, WHY
IS THAT? BECAUSE AND THEY'RE AND
THEY'RE TREATING OUR MOST ILL
INDIVIDUALS WHEN REALLY THE
INDIVIDUALS WITH THE MOST
TRAINING WE WOULD THINK SHOULD
BE TREATING THE PEOPLE WITH
REFRACTORY SCHIZOPHRENIA OR
REFRACTORY DEPRESSION. AND PART
OF THAT IS LOAN REPAYMENT, PART
OF THAT IS MEDI-CAL AND MEDICARE
REIMBURSEMENT. IT'S JUST NOT
FINANCIALLY SOLVENT FOR
INDIVIDUALS TO BE ABLE TO OFTEN
GO AND, YOU KNOW, DO THOSE DO
THOSE JOBS WHERE THEY CAN MAKE
MORE AND NOT HAVE TO DEAL WITH
INSURANCE. SO THAT'S PART OF
PART OF AN ISSUE. BUT, YOU KNOW,
WORKING WITH PEOPLE, I PRIMARILY
WORK WITH INDIVIDUALS WITH
SERIOUS AND PERSISTENT MENTAL
ILLNESS. AND THE ONE OF THE MOST
PROFOUND THINGS THAT YOU SEE IS
THIS IDEA THAT PEOPLE HAVE TO
FAIL UPWARDS WITHIN THE SYSTEM
WHEN WE IDENTIFY THEM AS HAVING
A SEVERE NEED. SOMEBODY WE
IDENTIFY IS GOING TO BE ILL AND
NEED HIGHER LEVELS OF CARE. WE
CAN'T ALWAYS GET THEM THAT
INITIALLY THEY HAVE TO GO
THROUGH WHATEVER COUNTY SYSTEM.
AND THAT'S THE OTHER PROBLEM IS
THAT THE COUNTIES HAVE VASTLY
DIFFERENT WAYS OF HANDLING
INTAKES AND EVEN THE CRITERIA
FOR SOME DIFFERENT PROGRAMS,
WHICH MAKES IT REALLY DIFFICULT
WHEN YOU'RE IN ONE HOSPITAL, IN
ONE COUNTY AND MAYBE LIVE AT
ANOTHER COUNTY, EVEN IF THAT
COUNTY HAPPENS TO BE FIVE
MINUTES AWAY, BUT THE, YOU KNOW,
INDIVIDUALS ARE NOT ABLE TO GET
THOSE HIGHER LEVEL SERVICES THAT
WE THINK THEY'RE GOING TO NEED.
AND THEN THEY THEY HAVE TO
ESSENTIALLY WASTE TIME, WASTE
ANOTHER HOSPITALIZATION. YOU
KNOW, THEIR, THEIR OWN, YOU
KNOW, POTENTIAL. DISABILITY IN
ORDER TO GAIN ACCESS, I WORKED
WITH A YOUNG MAN WHO HAD
SCHIZOAFFECTIVE DISORDER AND
BASICALLY BOUNCED BETWEEN
INPATIENT JAIL SETTINGS UNTIL AT
ONE POINT, HE ULTIMATELY, TRIED
TO TAKE HIS EYES OUT WHILE HE
WAS IN JAIL IN THE MIDST OF A
PSYCHOTIC EPISODE, AND WAS
PERMANENTLY BLINDED. AND THAT
WAS ACTUALLY THE ONLY THING THAT
LANDED HIM IN THE HOSPITAL FOR
LONG ENOUGH FOR US TO BE ABLE TO
FULLY STABILIZE HIM. AND NOW
HE'S DOING QUITE WELL, HAS A
WIFE, HAS A BABY, BUT
UNFORTUNATELY IT TOOK HIM DOING
SOMETHING THAT SEVERE FOR HIM TO
BE ABLE TO GET THE CARE THAT HE
NEEDS. AND THAT'S THE KIND OF
THAT'S THE PROBLEM WE'RE SEEING.
IT'S THIS REVOLVING DOOR WE SEE
PEOPLE THERE, THE CONTINUUM THAT
WE'VE BEEN THAT WE'VE BEEN
PROMISED OF CARE THAT'S GOING TO
EXIST WITH CARE COURT, THOSE
TYPES OF THINGS IS JUST NOT
COMING TO PASS. WE NEED A TRUE
CONTINUUM. A LOT OF THESE
HOUSING THAT OPTIONS THAT PEOPLE
ARE ARE HAVING AVAILABLE DO NOT
FIT THE UNIQUE NEEDS OF OUR
POPULATION. SOME CAN BE MUCH
MORE INDEPENDENT THAN OTHERS,
AND WE'RE WE'RE REALLY MISSING
THAT. AND THAT'S LEADING TO THIS
REPEATED REVOLVING DOOR
HOSPITALIZATION, THE YOU KNOW,
WE THE NUMBER ONE GOAL WE AS
PSYCHIATRISTS HAVE FOR OUR
PATIENTS IS TO SEE THEM
FUNCTIONAL, HAVING, YOU KNOW,
WORKING WITHIN THE COMMUNITY,
HAVING FAMILIES. BUT YOU KNOW,
THE CURRENT SYSTEM KIND OF
MISSES LOTS OF THERE'S GAPS
WHERE A LOT OF OUR PATIENTS
DON'T FIT. AND SO I THINK THAT'S
THE CHALLENGE THAT WE SEE IS
THAT WE'RE ALWAYS TRYING TO PUT
SQUARE PEGS INTO ROUND HOLES AND
FIND WHAT CAN WE HELP OUR
PATIENTS GET TO AND WHAT CAN WE
AND WHAT ARE THEY NOT ABLE TO
GET BECAUSE THEY DON'T HAVE A
REFERRAL FROM A PARTICULAR
AGENCY? AND IT'S, YOU KNOW, I
THINK IN THE END, THIS IS WHY
YOU HAVE A LOT OF PEOPLE NOT
WANTING TO WORK IN, IN, WITHIN
AGENCIES FOR ASSISTANCE, THE
HEALTH CARE AGENCIES OR, YOU
KNOW, ONES THAT ARE DEALING MORE
WITH, WITH, LARGER POPULATION OR
A MORE MEDI-CAL POPULATION
BECAUSE IT'S JUST FRUSTRATING.
IT'S FRUSTRATING. AND IT Þ, THE
OTHER I WOULD SAY ISSUE IS THAT,
YOU KNOW, THE SUPPORT STAFF IN A
LOT OF THESE PROGRAMS ARE NOT
PARTICULARLY THEY'RE THEY'RE
VERY THERE'S A HIGH LEVEL OF
TURNOVER, WHICH I DO THINK
SPEAKS TO POTENTIALLY THE
REIMBURSEMENT OR THE PAY AMOUNT
OF STRESS THAT THOSE INDIVIDUALS
ARE UNDER, BECAUSE WE KNOW THAT
WE AS PHYSICIANS CANNOT OPERATE
IN A VACUUM. WE NEED OUR SUPPORT
STAFF, WE NEED SOCIAL WORKERS,
WE NEED THERAPISTS. AND SO IF
NONE OF THOSE PEOPLE ARE
AVAILABLE, IT'S EXTREMELY
CHALLENGING. AND SO, YOU KNOW, I
WILL SAY, HAVING WORKED IN
ORANGE COUNTY FOR A NUMBER OF
YEARS, THINGS ARE A LOT BETTER
THAN THEY USED TO BE. BUT WE
ALSO KNOW THAT THERE CAN BE A
LOT OF IMPROVEMENTS. SO THANK
YOU. WELL, I DEFINITELY WANT TO
THANK YOU ALL SO MUCH FOR YOUR
PRESENTATIONS AND FOR BEING HERE
TODAY, DO HAVE A COUPLE OF
QUESTIONS FOR EACH OF YOU. YOU
SPOKE ABOUT LEARNING AND SCALING
UP. CAN YOU ELABORATE ON THAT A
LITTLE FURTHER? AND ALSO KIND
OF, GIVE EXAMPLES FOR WHOEVER
MAY BE PAYING ATTENTION HOW WE
DO THAT IN THE OTHER AREAS OF
HEALTH CARE. ABSOLUTELY.
PROBABLY SIX YEARS AGO WE
COMMISSIONED SOME RESEARCH BY UC
DAVIS TO LOOK AT ACCESS TO
SERVICES FOR FOLKS IN THE VERY
EARLY STAGES OF PSYCHOSIS. SO
THERE'S A NATIONAL RESEARCH
STUDY THAT THAT DOCUMENTS AN
EVIDENCE BASED PRACTICE. THE
RESEARCH WAS DONE WITH PEOPLE
WHO HAVE HAD THEIR FIRST EPISODE
OF PSYCHOSIS WAS WITHIN 18
MONTHS OF RECEIVING THESE
SERVICES. AND THE FEDERAL
GOVERNMENT HAS DOCUMENTED THAT
THIS PACKAGE OF SERVICE,
REFERRED TO AS COORDINATED
SPECIALTY CARE, IS HIGHLY
EFFECTIVE. IT CAN RESULT IN AS
MUCH AS A 74% REDUCTION IN
JUSTICE INVOLVEMENT FOR THE
PEOPLE THAT ARE SERVED. BUT WHEN
WE ASKED OUR SUBJECT MATTER
EXPERTS TO LOOK AT PROGRAMS
ACROSS THE STATE, THERE'S HUGE
VARIATION IN THE TYPE OF CARE
THAT PEOPLE RECEIVE, MANY
FAMILIES DON'T EVEN KNOW WHAT TO
ASK FOR, RIGHT? AND IF YOU
COMPARE THAT TO STROKE OR HEART
ATTACK OR DIABETES OR OBESITY,
PEOPLE HAVE EITHER A STRONG
UNDERSTANDING OF WHAT THE
EXPECTATIONS ARE OR THEY KNOW
WHERE TO GET THAT INFORMATION.
BUT PSYCHOSIS IS DIFFERENT. MOST
OF US ACTUALLY DON'T HAVE GOOD
GUIDANCE ON WHAT THAT MEANS,
WHAT TO LOOK FOR, WHO TO CALL,
AND THEN HOW TO ADVOCATE TO
RECEIVE EVIDENCE BASED PRACTICE.
MOST FAMILIES DON'T EVEN KNOW,
IF THE CARE THEY'RE RECEIVING IS
EVIDENCE BASED. WHEN WE MEET
WITH FAMILIES, WE AND WHEN WE
TALK WITH PRACTITIONERS, THEY'LL
TELL US THAT FAMILIES WILL SAY I
FOR THEIR CHILDREN. IT'S
TYPICALLY CHILDREN, LATE TEENS,
EARLY 20S THAT THEY WOULD RATHER
THEIR CHILD HAD CANCER THAN
SCHIZOPHRENIA, IN PART BECAUSE
THEY KNOW WHAT TO EXPECT, IN
PART BECAUSE THERE'S HOPE, WHEN
IN FACT WE HAVE AN EVIDENCE
BASED PRACTICE. IT'S HIGHLY
EFFECTIVE, BUT IT'S A ROLL OF
THE DICE IN A GIVEN COMMUNITY,
IF YOU WILL RECEIVE THAT, THERE
ARE HUGE WAIT LISTS. THERE ARE,
PROFOUND BARRIERS TO CARE IN
PART BECAUSE OF HOW WE PAY FOR
IT, BECAUSE OF HOW WE TRAIN OUR
PRACTITIONERS. SO MANY
PRACTITIONERS, DON'T ACTUALLY
KNOW IF THEY'RE DELIVERING AN
EVIDENCE BASED PRACTICE BASED ON
THE DIAGNOSIS. SO TOM AND DOCTOR
TOM INSEL, FORMER DIRECTOR OF
THE NATIONAL FOR MENTAL HEALTH,
HE'S HE'S WRITTEN AND SHARED
MULTIPLE TIMES THAT THE QUALITY
OF THE CARE, THE CARE YOU
RECEIVE IS OFTEN BASED ON THE
TRAINING OF THE PERSON IN FRONT
OF YOU, NOT YOUR DIAGNOSIS OF
YOUR NEED. SO WE HAVE A LONG WAY
TO GO, WE KNOW WHAT THE PRACTICE
IS. WE KNOW HOW TO DEPLOY IT.
THE GOOD NEWS IS THROUGH THE
CHILD YOUTH BEHAVIORAL HEALTH
INITIATIVE WITH MHC INNOVATION
FUNDS, THE STATE OF CALIFORNIA
IS STANDING UP STRATEGIES TO
DEVELOP MORE EVIDENCE BASED
FIRST EPISODE PSYCHOSIS PROGRAMS
ACROSS THE STATE. WE'RE WORKING
WITH THE PRIVATE SECTOR. WE'RE
WORKING WITH THE FEDERAL
GOVERNMENT. WE'RE WORKING WITH
LOTS OF PARTNERS, INCLUDING OUR
COUNTY BEHAVIORAL HEALTH
PARTNERS, TO REALLY SCALE THAT.
BUT IT'S SWIMMING AGAINST THE
CURRENT. IT'S VERY DIFFICULT TO
DO. SO MAYBE YOU CAN HELP ME
UNDERSTAND HOW THIS COULD EVEN
BE POSSIBLE WITHIN THE REALM OF
HEALTH CARE SPACE, BECAUSE WE
HAVE NATIONAL STANDARDS, WE HAVE
NATIONAL GUIDELINES WHICH ARE
EVIDENCE BASED. BUT WHY ARE WE
SEEING DIFFERENCES IN HOW THAT
IS DELIVERED? LIKE I THINK THE
FOR SPECIFICALLY THE FIRST
EPISODE, PSYCHOSIS, ONE OF THE
MAJOR ISSUES IS THE FUNDING HAD
A LOT OF THAT COMES FROM THAT.
IT'S NOT JUST MEDICATION THAT
HAS THE EVIDENCE BASED, IT'S ALL
THE OTHER INTERVENTIONS, THE
PSYCHOSOCIAL INTERVENTIONS, THE
FAMILY INTERVENTIONS AND CLINICS
ARE NOT ALWAYS, YOU KNOW, A
RANDOM YOU KNOW, CLINIC MAY NOT
BE ABLE TO DELIVER THAT. IF
THERE'S AN ISSUE WITH
REIMBURSEMENT, HOW ARE THEY. AND
THERE ARE SOME NEWER CODES
COMING OUT. BUT HOW ARE THEY
GOING TO ACTUALLY OBTAIN
REIMBURSEMENT FOR THOSE SERVICES
THAT ARE ESSENTIALLY
COLLABORATIVE AND, AND, AND
GOING ABOVE AND BEYOND THE
ACTUAL FACE TIME, SEEING THE
PATIENT, THERE THERE'S SO THAT'S
WHY THOSE TYPES OF THINGS, IT'S
REALLY HARD FOR, FOR PEOPLE TO
IMPLEMENT THEM WITHIN A CLINIC.
IT'S MUCH EASIER TO SAY, JUST GO
AND SEE SOMEBODY, YOU KNOW, SIT,
SIT IN THERE FOR, YOU KNOW, A
HALF HOUR OR WHATEVER, MAYBE,
HOPEFULLY NOT 15 MINUTES, BUT
MAYBE A LITTLE BIT MORE. BUT,
YOU KNOW, AND TO HAVE THEM TO
BUT TO HAVE THEM ACTUALLY BE
ABLE TO SEE THESE OTHER PEOPLE
BE PART OF OCCUPATIONAL AND, AND
, AND OCCUPATIONAL ACADEMIC
SUPPORTIVE SERVICES, THOSE ARE
ALL THE THINGS THAT TAKE PART
IN, FOR INSTANCE, THAT TYPE OF A
PROGRAM, AND THOSE ARE THE TYPES
OF PROGRAMS THAT ARE JUST HARD
TO ACCESS. THEY'RE MORE, MORE
EXPENSIVE, INSURANCE, A LOT OF
TIMES THESE ARE RUN THROUGH THE
COUNTY. AND SO INSURANCE DOESN'T
OFTEN KNOW HOW TO REIMBURSE
PRIVATE INSURANCE. SO IT CAN BE
ACTUALLY SOMETIMES DIFFICULT TO
KNOW WHERE TO REFER SOMEBODY
BASED ON THEIR INSURANCE, AND SO
I THINK PRACTITIONERS TRY TO DO
WHAT WE CAN TO BE WITHIN
EVIDENCE BASED CARE. BUT A LOT
OF THESE EVIDENCE BASED CARE
GUIDELINES FOR MENTAL HEALTH ARE
NOT JUST THE MEDICATION THÀNH.
IT'S THIS SUPPORTIVE NETWORK
THAT YOU REALLY NEED TO HAVE.
AND THAT'S GOING TO DEPEND ON,
YOU KNOW, THE QUALITY OF THE
TRAINING OF THOSE INDIVIDUALS,
YOU KNOW, LIKE KIND OF WAS
TALKING ABOUT LIKE IF THERE'S
TURNOVER LANGUAGE BARRIERS. AND
SO A LOT OF OUR INDIVIDUALS,
THEIR FAMILIES MAY SPEAK OTHER
LANGUAGES. AND SO ARE YOU HAVING
THOSE SERVICES BECAUSE A FAMILY
SERVICES AND IN THEIR, THEIR
LANGUAGE. AND SO IT CAN BE
FAIRLY COMPLICATED. AND SO A LOT
OF CLINICS HONESTLY HAVE SHIED
AWAY FROM, FROM DOING THIS. IS
THIS AN ISSUE THAT WE'RE SEEING
ACROSS THE COUNTRY OR IS THIS
UNIQUE TO CALIFORNIA? IF I MAY
JUMP IN ON THIS OVERALL QUESTION
AND, YOU KNOW, FIRST EPISODE,
PSYCHOSIS PROGRAMS HAVE LARGELY
BEEN BUILT UP BY OUR COUNTY
BEHAVIORAL HEALTH SAFETY NET
SYSTEM. AND WITH SUPPORT FROM
FUNDING THROUGH THE MHSA, AS
WELL AS, DIFFERENT FEDERAL
GRANTS THAT WE GET. AND THE WAY
THAT I LIKE TO PUT IT IS THAT,
WE HAVE A SYSTEM THAT IS, HAS
PATCHWORK BY DESIGN AND THAT
STARTS AT THE FEDERAL LEVEL WHEN
THE FEDERAL GOVERNMENT DECIDES
TO DO GRANTS, RIGHT, INSTEAD OF
STANDARDIZE BENEFITS FOR
SERVICES. AND THE EFFECTS OF
THAT SORT OF PIECEMEAL APPROACH,
POLICY WISE, ARE COMPOUNDED BY A
LACK OF COMPREHENSIVE, OF
QUALITY, ACCESSIBLE COVERAGE FOR
PEOPLE WITH COMMERCIAL
INSURANCE. RIGHT. WHICH IS LIKE
HALF OF THE MARKET AND THIS IS A
WARPING OF MARKET BASED HEALTH
CARE THAT WE DON'T REALLY SEE IN
PHYSICAL HEALTH IN THIS WAY,
WHICH IS WHY I SAID PEOPLE WITH
COMMERCIAL INSURANCE SIX TIMES
MORE LIKELY TO GO OUT OF NETWORK
AND PAY OUT OF POCKET. SO IF YOU
CAN'T GET WHAT YOU NEED FROM
YOUR PRIVATE INSURANCE PLAN,
YEAH, YOU'RE KIND OF SORT OF
LEFT TO YOUR OWN DEVICES. AND
THAT'S TRUE FOR BOTH THE
INDIVIDUAL AS WELL AS THEIR
PROVIDERS WHO SAY, GOSH, IT
WOULD BE REALLY GREAT IF YOU
COULD ACCESS THIS PROGRAM, AND
THAT PROGRAM MAY OR MAY NOT
EXIST IN YOUR COUNTY, AND IT MAY
OR MAY NOT BE AVAILABLE TO YOU
AS A PERSON WITH COMMERCIAL
INSURANCE. WHY IS THAT? BECAUSE
THE SAFETY NET IS NOT CURRENTLY
DESIGNED TO COVER EVERY SINGLE
CALIFORNIAN WITH A SPECIFIC
DIAGNOSIS, REGARDLESS OF
INSURANCE, RIGHT? WE DON'T HAVE
A SINGLE PAYER BEHAVIORAL HEALTH
SYSTEM. WE HAVE INSURANCE BASED
AND THE SAFETY NET MAY STEP IN
AND EXPAND A LITTLE BIT AND OPEN
ITS DOORS TO PEOPLE WITH
COMMERCIAL INSURANCE, BECAUSE WE
SEE THAT SOMETIMES IF WE DON'T
STEP THROUGH THAT DOOR AND LET
THEM IN, THAT PERSON MIGHT DIE.
AND THAT'S, YOU KNOW, THAT'S
UNFORTUNATELY THE REALITY WITH
MANY OF THESE CONDITIONS. OR
THEY MAY BECOME VERY SICK AND
THEN EVENTUALLY QUALIFY FOR OUR
SERVICES. AND SO WE HAVE SORT OF
A MORAL OBLIGATION. WE HAVE A
DESIRE TO BE HELPFUL WHEN WE
HAVE SOMETHING THAT DOESN'T
EXIST ELSEWHERE. BUT I THINK
PART OF THE QUESTION NEEDS TO BE
, HOW CAN WE GET ALL OF OUR
SYSTEMS TO PROVIDE THAT MORE
COMPREHENSIVE COVERAGE SO THAT
THAT THE SAFETY NET ISN'T SORT
OF HOLDING EVERYTHING? AND I
THINK IF WE GOT MORE PAYERS IN
AND IMPROVED THE, YOU KNOW,
REIMBURSEMENT AND OVERALL
FUNDING FOR THE SAFETY NET SIDE
OF THINGS, WE MIGHT START TO GET
TO A POINT WHERE THINGS ARE SORT
OF TURNING AROUND MORE BROADLY,
BUT IT HAS TO BE AN ALL IN
APPROACH. RIGHT? THE FULL SET OF
PAYERS HAVE TO BE AT THE TABLE.
THE PROVIDERS NEED TO BE
SUPPORTED SO THAT WE CAN BUILD
OUT MORE OF THESE PROGRAMS SO
THAT IT'S NOT SO SCARCE. THANK
YOU FOR THAT. YOU KNOW, ALONG
THE LINES OF, PAYERS AND
MEDI-CAL, AND, YOU KNOW,
COMMERCIAL INSURERS, WE KNOW
THAT MEDI-CAL REIMBURSEMENT
RATES ARE HORRIFICALLY LOW
WITHIN THE REALM OF BEHAVIORAL
HEALTH, AND UNFORTUNATELY, MANY,
PROVIDERS JUST DON'T TAKE ANY
KIND OF INSURANCE, EITHER
BECAUSE OF REIMBURSEMENT OR
BECAUSE OF PAPERWORK IS JUST TOO
ONEROUS, TO TRY TO GET THOSE
FUNDING BACK, DOCTOR SEGAN,
MAYBE YOU CAN ANSWER THIS
QUESTION BECAUSE I HAVE ASKED
MANY TIMES, AND NO ONE SEEMS TO
BE ABLE TO TELL ME HOW MANY
PSYCHIATRISTS, BOARD CERTIFIED
PSYCHIATRISTS DO WE HAVE HERE IN
THE STATE OF CALIFORNIA. OH,
SORRY, THAT'S A GOOD QUESTION. I
KNOW WE PART OF OUR ORGANIZATION
IS THREE ABOUT 3000. SO WE DON'T
REPRESENT ALL OF THEM, I CAN GET
BACK TO YOU ON THAT, THOUGH.
DEFINITELY. OKAY BECAUSE ONE OF
THE THINGS THAT I HAVE ASKED
MULTIPLE TIMES IS HOW MANY
PSYCHIATRISTS DO WE HAVE AND HOW
MANY OF THEM ACTUALLY TAKE
INSURANCE, RIGHT. YOU KNOW, I
WILL SAY, I THINK THE TIDE IS
TURNING A LITTLE BIT WITH, YOU
KNOW, MY RESIDENCY YEAR AND
RESIDENCY, YOU KNOW, CLASSES
THAT HAVE GRADUATED SINCE, I
THINK MORE INDIVIDUALS ARE BEING
ENTICED TO GO INTO THE COUNTY
SYSTEMS BECAUSE OF LOAN
REPAYMENTS, STAY IN ACADEMIC
SYSTEMS, SOME GO TO THE PRISONS.
THAT'S ACTUALLY BEEN A THEY'VE
THEY'VE DONE A VERY GOOD JOB OF
ENTICING PHYSICIANS AND
PSYCHIATRISTS THERE, AND SO I DO
THINK THAT THERE IS THERE IS
MOVEMENT IN THAT DIRECTION. BUT
WHAT I WOULD SAY, YOU KNOW, WE
AT OUR UNIVERSITY CLINIC, WE
HAVE A WAIT LIST OF SEVERAL
MONTHS FOR BECAUSE WE TAKE
MEDI-CAL, MEDICARE AND
COMMERCIAL INSURANCE AND WE'RE
JUST ONE, ONE CLINIC. BUT WE
HAVE A WAIT LIST OF SEVERAL
MONTHS FOR BOTH PSYCHIATRISTS
AND THERAPISTS. WOW AND CHAIR, I
WANT TO SAY WITH FUNDING FROM
KAISER FOUNDATION OF SOUTHERN
CALIFORNIA, CBA WORKED WITH UCSF
CENTER WORKFORCE CENTER AND
DOCTOR JANET KAUFMAN, AND SHE
DID AN ANALYSIS IN A REPORT THAT
WE PUBLISHED. AND I'M HAPPY TO
SHARE IT, THAT SHOWS THAT IN
CALIFORNIA, WE CURRENTLY HAVE
ROUGHLY 6000 PSYCHIATRISTS THAT
ARE LICENSED TO PRACTICE IN
CALIFORNIA. NOW WE HAVE ASKED
FOR MORE DATA ON SORT OF PAYER,
MIX AND THOSE SORTS OF THINGS,
AND WE'VE MADE THOSE
RECOMMENDATIONS TO HCCI, AS
THEY'RE ROLLING OUT THE VARIOUS
INITIATIVES THAT THEY HAVE,
THANK YOU FOR THAT FOR AT LEAST
GIVING ME A NUMBER, BECAUSE NO
ONE IN THE PAST HAS BEEN ABLE
TO. BUT I DO THINK THAT IS
SIGNIFICANT. AS WE TALK ABOUT,
WORKFORCE CHALLENGES, HIS
TRAINING QUESTION IS, DO WE HAVE
THE PROVIDERS OUT THERE, BUT
THEY'RE JUST NOT SEEING THE
PATIENTS. BECAUSE OF
REIMBURSEMENT. RIGHT, OR DO WE
NEED TO INCREASE THE NUMBER OF
PROVIDERS THAT WE HAVE, I KNOW A
SIGNIFICANT NUMBER OF PROVIDERS
DO NOT TAKE INSURANCE, ANY
INSURANCE. AND SO IT IS VERY
CHALLENGING FOR INDIVIDUALS TO
BE ABLE TO SEE THESE PEOPLE
BECAUSE THEY DO HAVE TO PAY OUT
OF POCKET. AND IT IS NOT,
INEXPENSIVE, ESPECIALLY IF YOU
NEED TO GO AND HAVE MULTIPLE
VISITS, WHAT ARE WE DOING TO
ENSURE THAT AS WE'RE ROLLING OUT
THESE DIFFERENT PROGRAMS, THAT
WE ARE, ROLLING THEM OUT IN A
WAY WHERE A VARIETY OF
COMMUNITIES WILL HAVE ACCESS AND
THAT WE ARE ENSURING THAT WE ARE
PROVIDING EQUITY AS WELL.
THERE'S A LOT IN THAT QUESTION.
THANK YOU, I, YOU KNOW,
CALIFORNIA, YOU KNOW, THROUGH
WORK THAT THE STARTED IN SOLANO
COUNTY REALLY HAS BEEN
PIONEERING STRATEGIES TO REALLY
ELEVATE COMMUNITY ENGAGEMENT TO
SUPPORT DISCUSSIONS ABOUT WHAT
SHOULD BE FUNDED, HOW IT SHOULD
BE FUNDED, WHERE PROGRAMS SHOULD
BE LOCATED, EVEN REALLY LOOKING
AT REDESIGNING SERVICES, EVEN
THE LANGUAGE THAT WE USED, WE'VE
SEEN DRAMATIC IMPROVEMENTS IN
PUBLIC TRUST, IN ACCESS TO CARE,
PARTICULARLY AMONG UNDERSERVED
OR INAPPROPRIATELY SERVED
COMMUNITIES, THAT IN PARTNERSHIP
WITH THE COMMISSION, BUT MOSTLY
THROUGH THE WORK OF THE COUNTY
BEHAVIORAL HEALTH DIRECTORS.
WE'VE REALLY BEEN ABLE TO EXPAND
SOME OF THESE APPROACHES. THIS
IS PART OF THIS. WE SUPPORT
LEARNING COLLABORATIVES. HOW CAN
WE LEARN AND SHARE MANY OF THOSE
BEST PRACTICES, BUT I ALSO WOULD
SAY THAT WE HAVE A LONG WAY TO
GO IN MAKING SURE THAT WE ARE
BEING RESPONSIVE TO THE NEEDS OF
PEOPLE. RIGHT. YOU KNOW, MY
COMMENTS EARLIER ABOUT, YOU
KNOW, THE PUBLIC NOT HAVING GOOD
PATHWAYS, GOOD GUIDANCE AND
UNDERSTANDING WHERE TO TURN TO.
I APPRECIATE THE IN-DEPTH ON THE
EARLY PSYCHOSIS STRATEGY, BUT
THAT'S ONE OF, YOU KNOW, THREE
DOZEN EXAMPLES, RIGHT? I THINK,
YOU KNOW, WE HAVE TO DO A BETTER
JOB ON THE COMMUNITY ENGAGEMENT
SIDE, AND WE ALSO HAVE TO DO A
BETTER JOB ON OUR CAPACITY TO
LEARN AROUND HOW THESE PROGRAMS
ARE WORKING OR NOT WORKING. WE
HAVE TO GET BETTER AT
UNDERSTANDING WHAT'S DRIVING
THESE IMPACTS AND REALLY
THINKING ABOUT OUR SYSTEMS
DESIGN, PARTICULARLY IN AREAS
LIKE CRIMINAL JUSTICE
INVOLVEMENT. RIGHT. THIS THE
STATE SUPPORTED AND MANY
COUNTIES ADOPTED WHAT'S CALLED A
SEQUENTIAL INTERCEPT MODEL. DO
EVERYTHING YOU CAN TO HELP
SOMEONE MOVE AWAY FROM THE
CRIMINAL JUSTICE SYSTEM WHEN
THERE'S A BEHAVIORAL HEALTH
NEED, WE'VE SORT OF, YOU KNOW,
LOST SOME FOCUS ON THAT AND
WE'VE LOST SOME INTENSITY IN
THAT AREA. AND, YOU KNOW, AND
THAT'S AN AREA WHERE WE SEE
PROFOUND DISPARITIES. WE SEE
PROFOUND CHALLENGES AROUND
PUBLIC TRUST, AND THE COSTS ARE
ENORMOUS RELATIVE TO WHAT WE
COULD DO. SO, YOU KNOW, WE'RE
VERY EXCITED ABOUT SOME OF THE
NEW CONVERSATIONS THAT ARE
HAPPENING UNDER UNDER PROP ONE
AROUND WORKFORCE, AROUND,
AROUND, AN ELEVATED ROLE FOR THE
DEPARTMENT OF PUBLIC HEALTH ON
PREVENTION AND ELEVATED ROLE FOR
THE STATE, IN PARTNERSHIP WITH
THE COUNTIES AROUND EARLY
INTERVENTION, THERE'S A LOT THAT
WE CAN DO, AND OTHER STATES ARE
ACTUALLY DOING A BIT MORE IN
UNDERSTANDING HOW TO THINK ABOUT
WHERE AREAS OF EARLY
INTERVENTION SHOULD BE SORT OF
THE FOCUS OF OUR INVESTMENTS AND
WHAT THOSE EARLY INTERVENTIONS
SHOULD BE. THIS, THIS SYSTEM OF
SCALING, IT IS VERY MUCH A
PATCHWORK BY DESIGN. AND BUT IN
ORDER TO SORT OF MOVE TOWARDS
MORE CONSISTENCY, MORE EFFECTIVE
SERVICES AND MORE ABILITY TO
LEARN WILL MEAN US THINKING
ABOUT HOW CAN THE STATE PROVIDE
MORE TECHNICAL ASSISTANCE AND
SUPPORT FOR OUR LOCAL PARTNERS,
BOTH ON THE PUBLIC SECTOR SIDE
AND THE COMMERCIAL INSURANCE
SIDE, FROM THIS SORT OF BROAD
POPULATION HEALTH LENS? SO, YOU
KNOW, THE GOOD NEWS IS, YOU
KNOW, WE ACTUALLY KNOW HOW TO DO
SO MUCH OF THIS. THE CHALLENGE
IS RESOURCES. KIND OF, YOU KNOW,
WORKFORCE CAPACITY. AND IT'S
GOING TO BE REALLY IMPORTANT TO
ALIGN AND LINE UP THOSE
INVESTMENTS IN WAYS THAT HELP US
THINK STRATEGICALLY. YOUR
QUESTION ABOUT HOW MANY
PSYCHIATRISTS DO WE HAVE VERSUS
HOW MANY DO WE NEED RELATIVE TO
HOW CAN WE MAKE THAT BEHAVIORAL
HEALTH NEED THROUGH A MUCH MORE
DIVERSE WORKFORCE STRATEGY,
WHICH WE'VE SEEN IN NURSING, FOR
EXAMPLE, WHERE WE'VE DIVERSIFIED
THE FIELD PRETTY DRAMATICALLY,
THE NEW BEHAVIORAL HEALTH COACH,
COMPONENT OF OUR WORKFORCE IS
ESSENTIAL, REALLY LEVERAGING OUR
SCHOOLS, REALLY LEVERAGING OUR
COMMUNITY BASED ORGANIZATIONS,
PARTICULARLY IN RURAL
COMMUNITIES, IN IN COMMUNITIES
THAT ARE SUBURBAN OAN OR
DIVERSE LANGUAGE, DIVERSE
ETHNICITY, IT'S NOT A SIMPLE
QUESTION. IT'S ACTUALLY A PRETTY
COMPLICATED QUESTION, BUT I
THINK IT'S THE KEY CHALLENGE
THAT CALIFORNIA HAS TO DO BETTER
ON, MADAM CHAIR, IF I MAY. ALSO,
I WANT TO GIVE A COUPLE OF
SPECIFIC EXAMPLES OF THE WAY
THAT WE CAN REALLY MAXIMIZE AND
LEVERAGE THE STATE'S ONE TIME
INVESTMENTS, IN PARTICULAR ON
THE WORKFORCE SIDE, WE KNOW, AS,
MR. EWING STATED, THAT IT IS
REALLY POSSIBLE TO TURN
WORKFORCE SHORTAGES AROUND. THIS
IS A SIMPLE FORMULA OF EXPANDING
SLOTS AND INCREASING PAY SO THAT
PEOPLE HAVE A LIVING WAGE. ON
THE OTHER SIDE OF THAT, THAT
SCHOOLING, RIGHT. CURRENTLY,
COUNTY BEHAVIORAL HEALTH IS
LOSING STAFF TO THE FAST FOOD
SECTOR OFTENTIMES. AND SO WE
NEED TO BE FAR MORE COMPETITIVE
THAN WE ARE, AND IN TERMS OF
EXPANDING SLOTS, OUR WORKFORCE
REPORT ALSO LOOKS AT GEOGRAPHIC
REGIONAL DIFFERENCES AND
DISPARITIES. THE SAN JOAQUIN
VALLEY BY FAR OUTPACES THE REST
OF THE STATE IN HAVING THE
BIGGEST NEED. SO IF WE EXPANDED
SLOTS IN THE CENTRAL VALLEY, WE
WOULD DRAW FROM A MORE DIVERSE,
POPULATION OF STUDENTS AND HELP
TO ENSURE THAT MORE OF THEM
STAYED IN THOSE COMMUNITIES TO
PRACTICE WHERE THEY'RE SO
DESPERATELY NEEDED. WE ALSO NEED
TO CHANGE THE QUALITY OF THE
EDUCATION. SO THE CURRICULUM
NEEDS TO BE FAR MORE ORIENTED
TOWARD SAFETY NET RATHER THAN
SOME OF THOSE SELF-PAY PRIVATE
PRACTICE KIND OF, ORIENTATIONS
THAT SO MANY OF THE SCHOOLS
CURRENTLY HAVE. UNFORTUNATELY,
THEY'RE TRAINING PEOPLE FOR A
SINGLE SHINGLE RATHER THAN FOR,
WORKING IN HIGH TOUCH, CRISIS
ORIENTED, FIELD BASED, HOME
BASED. OUR DIRECTORS ARE SEEING
THAT, AND THEY'RE DISMAYED IF
THESE PUBLIC DOLLARS ARE ROLLING
OUT, WE CAN ATTACH STRINGS TO IT
TO SAY, THIS IS WHAT WE WANT IN
TERMS OF CURRICULUM. SO SIMPLE
FORMULA EXPAND THE SLOTS. WE
WOULD SUGGEST PUT THOSE SLOTS IN
PLACES WHERE IT'S MORE DIVERSE
AND NECESSARY, AND THEN ATTACH
SOME STRINGS TO THOSE DOLLARS.
SIMILARLY, ON THE CONTINUUM SIDE
OF THINGS, WE HAVE SOME
EXTRAORDINARY COUNTY BEHAVIORAL
HEALTH DIRECTORS WHO SAY I
HARDLY NEED TO CONSERVE ANYONE
BECAUSE I'VE INVESTED SO DEEPLY
IN MY OUTPATIENT SERVICES AND IN
MY UPSTREAM INTERVENTIONS. THE
GOAL SHOULD NOT BE FOR US TO GET
BULKY ON THE HIGH END OF THE
CONTINUUM. IT SHOULD BE FOR US
TO BULK UP ON THE EARLY
INTERVENTION AND OUTPATIENT SIDE
OF THINGS. AND SO I THINK WE
NEED TO LOOK AT THAT AS WE'RE
BUILDING OUT WHAT WE'RE BUILDING
OUT. BECAUSE IF YOU BUILD IT,
YOU THEN NEED TO SUSTAIN IT
RIGHT OVER THE LONG RUN. AND
WHAT WE DON'T WANT TO SEE IS A
TON OF CRISIS SERVICES, A TON OF
ACUTE AND INPATIENT. BUT THAT
MEANS WE NEED TO BRING A BUNCH
MORE PEOPLE INTO THE DISCUSSION
AND THE CONVERSATION ABOUT
ACCOUNTABILITY AND ENSURING THAT
ACCESS TO QUALITY OUTPATIENT
EARLY INTERVENTION SERVICES AND
THERE NEEDS TO BE THAT
MONITORING ACROSS MULTIPLE
PAYERS. ALSO DELIVERY SYSTEMS
WITHIN MEDI-CAL, SO THAT WHEN
PEOPLE PRESENT WITH A NEED
EARLY, NOT JUST THE INDIVIDUAL
BUT THEIR PRIMARY CARE DOCTOR
KNOWS WHAT TO DO, TOO MANY
PRIMARY CARE PHYSICIANS
UNFORTUNATELY DON'T KNOW WHAT TO
DO WHEN PRESENTED WITH THOSE
ISSUES. ALSO ABOUT WITH REGARD
TO KIND OF DIVERSITY, I THINK WE
KNOW THAT THERE ARE BETTER
OUTCOMES WHEN PEOPLE HAVE A
PHYSICIAN THAT LOOKS LIKE THEM,
IT SPEAKS THEIR SAME LANGUAGE.
AND SO THERE'S A COUPLE OF
THINGS. I MEAN, AT THE VERY TOP,
WE NEED TO BE RECRUITING AND
CONTINUING TO SUPPORT PEOPLE
WHO, YOU KNOW, SPEAK SPANISH,
SPEAK, YOU KNOW, IN ORANGE
COUNTY, VIETNAMESE IS A IS A
LARGE MINORITY WHO SPEAK THESE
LANGUAGES TO STAY WITHIN
COMMUNITY SETTINGS, THE OTHER
THING WE NEED TO DO, AND THIS
GOES IS MORE OF A FEDERAL ISSUE
IS HOW DO WE ACTUALLY WE NEED
WE'RE WE'RE SHORT ON ON
PHYSICIANS. THERE'S GOING TO BE
MULTIPLE PEOPLE RETIRING. WE ARE
EVEN IF WE'RE NOT WE'RE SHORT
NOW, BUT WE'RE GOING TO BE EVEN
MORE SHORT AS THINGS COME IN.
AND SO, THE HAVING CONGRESS
INCREASE THE AMOUNT OF RESIDENCY
SLOTS IS ESSENTIAL BECAUSE WE
CAN'T MAKE MORE DOCTORS WITHOUT
MORE RESIDENCY SPOTS. AND ALSO
HAVING AND THEN WE CAN HAVE MED
SCHOOLS WORK ON RECRUITING INTO
MORE, YOU KNOW, THERE'LL BE MORE
MED SCHOOLS. WE CAN RECRUIT A
MORE DIVERSE APPLICANT POOL
BECAUSE RIGHT NOW, YOU KNOW,
THIS GOES DOWN TO, YOU KNOW,
WHERE PEOPLE ARE BORN AND HOW
LIKELY THEY ARE TO GET INTO
MEDICAL SCHOOL JUST FROM THE
MOMENT THAT YOU KNOW WHERE
THEY'RE BORN INTO. SO THAT BEING
ALL SAID, I THINK, YOU KNOW, WE
NEED TO HELP PEOPLE STAY WHERE
THEY'RE, THEY'RE THEY'RE NEEDED
THE MOST. AND THAT WE DO KNOW
THAT A LOT OF PEOPLE DO STAY
WHERE THEY TRAIN, I WILL SAY, I
THINK FROM THE PSYCHIATRIST
STANDPOINT, IT'S THE SINGLE
SHINGLE IS ACTUALLY A LOT LESS
COMMON THAN IT USED TO BE. IT'S
JUST IT I THINK IT'S JUST A LOT
HARDER TO DO. YEAH, IT'S APPS.
SO YEAH, GOING TO APPS IS ONE
THING PEOPLE DO DOING LIKE
THROUGH. YEAH BUT AT LEAST THEY
TAKE INSURANCE WHICH IS BETTER
THAN, THAN THAN JUST NOTHING.
BUT I THINK THERE IS, THERE IS A
PULL AGAIN, I THINK A LOT MORE
PEOPLE ARE GOING INTO, YOU KNOW,
COMMUNITY PROGRAMS, BUT WE NEED
TO MAKE IT ENTICE THEM TO STAY
THERE, AND THEN WITH REGARD TO
THE YOU KIND OF MENTIONED JUST
AS A SIDE POINT, THE CONTINUUM
AND WHERE SHOULD WE SHOULD
INVEST. I DO WANT TO MAKE SURE
HAVING WORKED IN INPATIENT, THAT
WE'RE NOT FORGETTING THAT THERE
IS A GROUP OF INDIVIDUALS THAT
NO MATTER WHAT WE DO, THEY ARE
GOING TO BE ILL AND NEED HIGHER
LEVELS OF CARE AND RIGHT NOW, AT
ANY GIVEN POINT IN TIME, WE HAVE
UP TO 50% OF OUR INPATIENT BEDS
UTILIZED BY PEOPLE WHO ARE
WAITING FOR A LONG TERME CARE
BED. AND SO THAT'S ANOTHER
ASPECT OF BOTTLENECKING THAT'S
AND THAT GOES AGAIN, ALSO TO
PART OF THE FEDERAL, THE IMD
EXCLUSION ACT AND EVERYTHING.
BUT YOU KNOW THERE IT'S HARD.
AGAIN, WE HAVE DIFFERENT
POPULATIONS WITH VERY DIFFERENT
NEEDS. AND WE'RE TRYING THIS IS
A SYSTEM WHERE WE'RE TRYING TO
MEET THE NEEDS OF ALL THESE
DIFFERENT POPULATIONS. AND SOME
ARE GOING TO BE MUCH MORE
RELIANT AND HAVE A LOT OF
BENEFIT WITH THE WITH THE
OUTPATIENT. SOME PEOPLE NEED THE
CONTINUED STRUCTURE OF A OF A,
NOT EVEN NECESSARILY INPATIENT
BUT OF A SUPPORTED LIVING. SO
IT'S A GOOD TALK FOR A LONG TIME
ABOUT THIS. YES, I, I UNDERSTAND
PSYCHIATRY IS A VERY BROAD
BEHAVIORAL HEALTH IS A VERY
BROAD FIELD. I DO TEND TO HOPE
THAT WE COULD FOCUS A LITTLE BIT
MORE ON THE PREVENTATIVE ASPECT
AND THE EARLY INTERVENTION AND
BEEF THAT UP. THERE ARE PEOPLE
WHO WILL NEED INPATIENT AND
CHRONIC CARE. BUT I THINK WHAT
I'M SEEING A LOT OF IS THAT
THINGS THAT COULD HAVE BEEN
MANAGED EARLY ON, END UP IN THE
HOSPITAL LONGER TIME CARE
BECAUSE WE DID NOT TAKE CARE OF
IT EARLIER. NOW THERE ARE SOME
DIAGNOSES THAT ARE MUCH MORE
CHALLENGING, AS YOU KNOW, THAN
OTHERS, BUT I THINK WE HAVE
UNFORTUNATELY ENTERED AN ERA
WHERE A LOT OF PEOPLE END UP IN
THE HOSPITAL THAT REALLY DON'T
NEED TO BE HAD. THEY HAD THE
RESOURCES AND THE EARLY
INTERVENTION, WANTED TO ASK YOU
A QUESTION, THOUGH. WHEN YOU
WHEN YOU TALK ABOUT THE
DIFFERENT TRAINING PROGRAMS, ARE
YOU REFERRING TO OUR PHYSICIANS?
ARE YOU REFERRING TO OUR NURSES?
WHO ARE WHO ARE YOU REFERRING
TO? IT'S REALLY ACROSS THE
BOARD. YOU KNOW, WE ARE. SO WHEN
WE DID THE WORKFORCE ANALYSIS
WITH UCSF, WE LOOKED AT WHO IS
CURRENTLY, SERVING MEDI-CAL
BENEFICIARIES AS PART OF THE
COUNTY BEHAVIORAL HEALTH SAFETY
NET, RIGHT? IT'S A VERY DIVERSE
ARRAY, DEPENDING ON WHETHER IT'S
MENTAL HEALTH OR SUBSTANCE USE
DISORDERS, AND THEN WE ALSO
LOOKED AT WHAT AVAILABLE DATA WE
HAD ON GENDER, RACE, ETHNICITY,
LANGUAGE. SO I CAN GIVE YOU KIND
OF LIKE THE VERY OVERSIMPLIFIED
VERSION. WE HAVE A
DISPROPORTIONATE SHARE OF WHITE
WOMEN WORKING IN THE, SAFETY NET
, BECAUSE THAT'S THE POOL OF
LICENSED PROFESSIONALS THAT
WE'RE DRAWING FROM, WE HAVE, YOU
KNOW, AND I CAN LOOK IT UP. WE
HAVE, SOCIAL WORKERS, WE HAVE
LMFT, WE HAVE, ON THE SORT OF
LICENSE SIDE, PSYCHIATRIST,
NURSE PRACTITIONER, OWNERS,
PRESCRIBERS ARE A BIG DEAL. FOR
EXAMPLE, IF WE WANT TO EXPAND
ACCESS TO MEDICATION ASSISTED
TREATMENT FOR PEOPLE WITH
SUBSTANCE USE DISORDERS, WE
REALLY NEED TO BRING PHARM MANY
MORE PRESCRIBERS INTO THE COUNTY
BEHAVIORAL HEALTH SAFETY NET SO
THAT WE CAN GET PEOPLE STARTED
ON MEDICATION ASSISTED
TREATMENT. AND THOSE ARE BOTH
NURSE PRACTITIONERS AS WELL AS
PHYSICIANS. RIGHT, BUT WE ALSO
RELY PRETTY SIGNIFICANTLY IN THE
SAFETY NET ON PARAPROFESSIONALS
OR, NOT NON LICENSED
INDIVIDUALS. WE NEED MORE DATA
AROUND THAT FOR SURE. WE'RE
BUILDING OUT THE PEER BENEFIT IN
MEDI-CAL. WE'RE GOING TO START
TO BE ABLE TO HAVE A COMMUNITY
HEALTH WORKER BENEFIT UNDER THE
CONNECT WAIVER. AND SO, IT'S
SORT OF I WOULD SAY IT'S A BOTH
END. RIGHT. WE NEED TO, BOTH
DIVERSIFY THE POOL OF
INDIVIDUALS WHO ARE COMING OUT
OF THESE SCHOOLS AS LICENSED OR
CERTIFIED INDIVIDUALS, AS WELL
AS EXPAND. AND THE GROUP OF
PEOPLE WHO ARE UNLICENSED OR MAY
BE CERTIFIED AS COMMUNITY HEALTH
WORKERS, PEERS, ETC. BECAUSE IN
SPECIALTY BEHAVIORAL HEALTH,
WHICH I KNOW, THIS IS SLIGHTLY
DIFFERENT FROM THE MEDICAL
MODEL, A PEER SUPPORT SPECIALIST
SERVICE CAN REALLY BE A MAKE OR
BREAK INTERVENTION FOR SOMEBODY
LONG TERME RECOVERY TRAJECTORY,
RIGHT. AND THAT PUTS THE PEER ON
A VERY DIFFERENT, MORE EVEN
FOOTING WITH SOME OF THE MEDICAL
PROFESSIONALS WHO ARE IN OUR
SPHERE AND GETS TO SOME OF THAT
BIOPSYCHOSOCIAL DYNAMIC THAT IS
REALLY UNIQUE. AND, YOU KNOW, MY
HOPE IS THAT WE BRING SOME OF
THAT ETHIC, THE NOTHING ABOUT US
WITHOUT US SORT OF DISABILITY
JUSTICE ETHOS INTO THE MEDICAL
MODEL AS WE'RE SORT OF BUILDING
OUT, INTERVENTIONS THAT CUT
ACROSS POPULATIONS. THANK YOU.
SO I AM, SURPRISED AND CONCERNED
WITH THIS KIND OF, LIKE,
PATCHWORK SYSTEM THAT WE HAVE
WITHIN OUR BEHAVIORAL HEALTH
SYSTEM, WHICH HAS BEEN POINTED
OUT, WE DON'T REALLY SEE IN
OTHER, OTHER AREAS OF MEDICINE,
WITH WITH ALL OF THE THINGS THAT
THE STATE IS DOING ALL OF THE
MONEY, ALL OF THE FOCUS, ALL OF
THE INITIATIVES THAT WE'RE
DOING, DO YOU SEE THIS IMPROVING
WITH WHAT WE ARE PROPOSING OR
CURRENTLY DOING? FROM THE
STANDPOINT OF A CLINICIAN, I
WOULD SAY WE'VE HAD IMPROVEMENTS
OVER THE LAST TEN YEARS, BUT I
FEEL LIKE WE'VE KIND OF
PLATEAUED IN TERMS OF WHAT WHAT
WE HAVE TO OFFER. I THINK THE
OTHER DIFFICULT PART IS THAT IF
I WERE WORKING IN ANOTHER
COUNTY, MY STRATEGIES WOULD BE
DIFFERENT BECAUSE THEY HAVE
DIFFERENT, YOU KNOW, CRITERIA,
DIFFERENT AVAILABILITY OF
SERVICES AND WITHIN THE COUNTY.
AND SO THAT CAN BE KIND OF A
CHALLENGE, HOW HOW QUICKLY
SOMEBODY CAN BE SEEN, THOSE
TYPES OF THINGS AND SO I DO FEEL
LIKE WE'VE KIND OF WE'VE
DEFINITELY IMPROVED. BUT WE'VE
KIND OF REACHED A PLATEAU OF
WHERE WE'RE WHERE WE'RE GOING.
AND I THINK I'M GOING TO BE
HONEST, ONE OF THE BIG THINGS IS
THE LACK OF HOUSING, OR THE
AVAILABILITY OF, AGAIN,
SUPPORTED ENVIRONMENTS TO HELP
PEOPLE STAY OUT OF THE HOSPITAL,
TO HELP THEM STAY WELL AND, YOU
KNOW, AT ACROSS THE LIFESPAN YOU
KNOW, FROM FROM WE HAVE, YOU
KNOW, 18 YEAR OLDS OR ACTUALLY I
MEAN, I TREAT ADULTS BUT WE HAVE
PEOPLE WHO ARE, YOU KNOW, KIDS,
YOUNG ADULTS TO, YOU KNOW, OLDER
ADULTS. AND SO WE NEED TO MAKE
SURE THAT WE'RE WE'RE SUPPORTING
ALL OF THEM, IF I MAY, IN TERMS
OF THE VARIATION, I THINK THAT
GOES TO SOME OF THE GRAND SPACED
APPROACHES THAT WE HAVE IN OUR
SYSTEM. AND SO I JUST WANT TO BE
REALLY CLEAR, THE MEDI-CAL
CRITERIA ARE MOSTLY CONSISTENT,
WHERE THERE ARE DIFFERENCES IN
THE MEDI-CAL CRITERIA, IT OFTEN
DOES COME DOWN TO THE FISCAL
RIGHT, BECAUSE THE STATE HAS A
VERY UNIQUE WAY OF PAYING FOR
SPECIALTY BEHAVIORAL HEALTH
SERVICES. THEY EARMARK CERTAIN
TAX REVENUES TO COUNTY
BEHAVIORAL HEALTH, AND IT SERVES
AS SORT OF A GLOBAL BUDGET
RATHER THAN A PER MEMBER PER
MONTH. ACTUARIALLY SOUND RATE.
RIGHT. AND SO WITHIN THAT GLOBAL
BUDGET, COUNTIES HAVE TO MANAGE
THE ENTITLEMENT RESPONSIBILITY
WITH THE UNFUNDED ACUTE
INPATIENT AND HIGH LEVEL
SERVICES. THE UNDERFUNDED CRISIS
SERVICES. SO YOU HAVE SORT OF
THE BY DESIGN PART IS
MULTIFACTORIAL. I WILL SAY, AND
SO GETTING US TO A MORE
STANDARDIZED SYSTEM WOULD
REQUIRE HAVING MORE CONSISTENT
BENEFITS ACROSS COMMERCIAL AND
SAFETY NET, RIGHT, PUBLIC AND
PRIVATE. IT WOULD ALSO REQUIRE,
HAVING, FEWER OPTIONAL BENEFITS
IN COUNTY BEHAVIORAL HEALTH. AND
THAT'S REALLY A FUNCTION OF
REALIGNMENT, RIGHT. WHERE THE
STATE SAID, HERE'S YOUR
DEDICATED REVENUE STREAM. THESE
ARE THE THINGS THAT COUNTIES
AGREE TO PAY FOR. BUT AFTER
2011, IF THE STATE WANTS TO ADD
NEW RESPONSIBILITIES, THE STATE
HAS TO PAY FOR THE NONFEDERAL
SHARE OF THOSE MEDI-CAL
SERVICES. SO WE SEE EXAMPLES
LIKE MOBILE CRISIS, WHERE THE
STATE WENT ABOVE AND BEYOND AND
PAYS, PICKS UP THE NONFEDERAL
SHARE FOR MOBILE CRISIS. AND SO
THAT'S BEEN STRUCTURED AS A
STATEWIDE BENEFIT. BUT THINGS
LIKE DRUG MEDI-CAL, ORGANIZED
DELIVERY SYSTEM, WHICH PROVIDES
THAT COVERAGE FOR RESIDENTIAL
INPATIENT SUBSTANCE USE DISORDER
TREATMENT SERVICES, IS
STRUCTURED AS AN OPTIONAL
BENEFIT. SO ONLY IF THE COUNTY
CAN FIND THE RESOURCES IN THEIR
EXISTING BUDGET TO MAKE ROOM FOR
THAT NEW EXPANDED BENEFIT. ARE
THEY GOING TO STAND IT UP? AND
THAT SAME DYNAMIC KEEPS PLAYING
OUT AND IT KEEPS REINFORCING THE
PATCHWORK WITHIN MEDI-CAL,
WITHIN THE SAFETY NET, RIGHT. SO
WE'VE GOT A PATCHWORK THERE. BUT
THERE ARE OTHER PATCHWORKS. AND
I MEAN, IT'S A REALLY
FASCINATING TALE, BUT IT IT
LEADS TO PEOPLE FALLING THROUGH
THE CRACKS. AND IT ALSO LEADS TO
PROVIDERS WHO COULD NEVER YOU
KNOW, HOPE TO UNDERSTAND WHAT
ALL OF THE VARIOUS ORIGIN
STORIES ARE BEHIND THIS. AND
THEN THEY JUST, YOU KNOW, FEEL
FRUSTRATED AND CONFUSED.
UNDERSTANDABLY SO. I CAN GIVE
JUST THE EXAMPLE THAT I HAD THAT
KIND OF COMES TO MIND IS
ASSISTED OUTPATIENT TREATMENT,
WHICH IS LAURA'S LAW IN IN IF WE
PLACE A REFERRAL IN ORANGE
COUNTY. AND OBVIOUSLY THESE ARE
MUCH DIFFERENT SIZE COUNTIES,
THEY'LL COME USUALLY WITHIN A
FEW DAYS TO EVALUATE THE PERSON
IN THE HOSPITAL. WHEN WE HAVE AN
LA COUNTY RESIDENT, THEY'LL BE
ON A LIST, THEY SAID. THEY'LL
PROBABLY TRY TO GET TO THE
PATIENT WITHIN MONTHS. AND SO
AGAIN, THAT'S AN EXAMPLE OF
SOMETHING THAT WE OBVIOUSLY CAN
UNDERSTAND WHY IT'S PROBABLY A
RESOURCES ISSUE, BUT THAT CAN BE
A POINT OF INTERVENTION. AGAIN,
I THINK WE'RE ALL LOOKING FOR
WHAT ARE THE POINTS OF
INTERVENTION THAT CAN COST LESS
THAN WHAT COSTS, YOU KNOW, THAN
WHAT'S GOING TO HAPPEN? FIVE
STEPS DOWN. AND SO THAT'S THAT'S
AN EXAMPLE, WHICH I THINK AGAIN
GOES TOWARD LIKE IT'S NOT THAT
THEIR CRITERIA IS DIFFERENT,
IT'S JUST THAT THE RESOURCES ARE
DIFFERENT OR RESOURCES ARE MAYBE
IN THE COUNTY. YEAH IF I MAY, I
THINK, LEFT ON ITS OWN. WE WILL
JUST REINFORCE THE PATCHWORK.
BUT IF THE STATE SAYS SAYS, YOU
KNOW, HERE'S WHERE WE WANT TO
DEVELOP A STRATEGIC INITIATIVE
TO CREATE THAT CONSISTENCY WITH,
WITH, YOU KNOW, CONSISTENT
UNDERSTANDING OF, OF KIND OF
DATA REPORTING. RIGHT? WE DON'T
HAVE STRONG DATA REPORTING
REPORTING SYSTEMS IN THIS STATE,
AS EVIDENCED BY YOUR QUESTION OF
WE DON'T EVEN KNOW HOW MANY
PSYCHIATRISTS THERE ARE CHILD
PSYCHIATRISTS VERSUS NOT, YOU
KNOW, ADULT PSYCHIATRISTS WHO'S
SERVING WHOM. RIGHT, IF WE BUILT
FISCAL INCENTIVES, WHICH THE
STATE HAS DONE UNDER SAIBAI AND
SOME PRETTY PHENOMENAL WAYS,
THEY'RE USING THOSE DOLLARS.
DC'S OTHER DEPARTMENTS ARE USING
THOSE DOLLARS TO INCENTIVIZE
SCALING TO REDUCE THE PATCHWORK
NATURE, PARTICULARLY IN THE
SCHOOL SPACE, BUILDING OUT
TECHNICAL ASSISTANCE BECAUSE
MANY OF OUR COMMUNITY PARTNERS
AT THE COUNTY LEVEL. BUT BUT
ALSO COMMUNITY BASED
ORGANIZATIONS AND EVEN ON THE
COMMERCIAL SIDE ARE ARE
INTERESTED AND WANT TO RECOGNIZE
THIS, SORT OF, YOU KNOW,
INCREASED USE OF EVIDENCE BASED
PRACTICE. THERE'S A THERE'S A
THIRST TO LEARN, TO TRY TO
IMPROVE, MORE COMMUNITY
ENGAGEMENT AROUND WHAT
EXPECTATIONS ARE. FRANKLY, I
THINK, YOU KNOW, IF THAT WAS MY
FAMILY MEMBER IN THAT HOSPITAL
IN IRVINE IN ORANGE COUNTY SAID,
I'LL BE THERE IN TWO DAYS. AND
LÀ SAID, FOUR MONTHS, RIGHT. AND
ESPECIALLY IF I WAS PAYING THE
BILL FOR FOUR MONTHS IN A
HOSPITAL, I DON'T KNOW WHO PAYS
THE BILL FOR FOUR MONTHS IN A
HOSPITAL WHEN IT SHOULD BE FOUR
DAYS. RIGHT. AGAIN, I THINK
THERE'S AN EXAMPLE OF WE'VE, YOU
KNOW, THE LACK OF STANDARDS, THE
LACK OF ATTENTION, THE LACK OF
TECHNICAL ASSISTANCE. YOU KNOW,
JUST THAT PERSISTING PIECE
AROUND, UNDERSTANDING WHAT WE'RE
TRYING TO GET DONE, DEVELOPING
THE STRATEGY TO SCALE,
UNDERSTANDING WHY IT'S NOT
HAPPENING ON THE NATURAL.
WITHOUT THOSE INVESTMENTS, WE'RE
VERY LIKELY TO JUST REINFORCE
THE PATCHWORK THAT WE HAVE WITH
THOSE INVESTMENTS. CALIFORNIA
CAN MOVE TOWARDS A MORE
CONSISTENT APPROACH TO
DELIVERING CARE THAT IS HIGHLY
EFFECTIVE, THAT IS AVAILABLE
FASTER. IT WILL MEAN
UNDERSTANDING, THE FISCAL
DYNAMICS AND OTHER INCENTIVES
THAT ARE GETTING IN THE WAY,
WHICH AND IT IS JUST FINANCE. IT
CAN BE LICENSING, IT CAN BE FOR
INDIVIDUAL STAFF OR FACILITIES.
WE'RE TRYING TO SCALE AN
APPROACH RIGHT NOW THAT PUTS,
SORT OF A CRISIS STABILIZATION
UNIT NEXT TO AN EMERGENCY
DEPARTMENT. SO IN ONE COMMUNITY,
SOMEONE COMES IN LAW ENFORCEMENT
BRINGS THEM THERE, THEY COME IN
ON THEIR OWN, THEY'RE IDENTIFIED
AS POTENTIALLY HARM TO SELF OR
OTHERS. THEY'RE ASSESSED BY THE
HOSPITAL AND BY THE EMERGENCY
DEPARTMENT. AND THEY SAY THEY'RE
NOT BLEEDING. THEY'RE NOT HAVING
A STROKE OR A HEART ATTACK.
THEY'RE STABLE, BUT THEY NEED
BEHAVIORAL HEALTH CARE, ONE
HOSPITAL, YOU'LL SIT THERE FOR
FOUR DAYS TO TRY TO FIND A
PLACEMENT. WE'RE WORKING WITH A
HALF A DOZEN, EIGHT OR SO
HOSPITALS TO BUILD A CRISIS
STABILIZATION UNIT 20FT AWAY.
YOU WALK OUT OF THAT EMERGENCY
DEPARTMENT WITHIN, YOU KNOW,
FOUR HOURS AND GET STABILIZED,
PROFOUNDLY, REDUCE COSTS,
IMPROVE OUTCOMES. WE DON'T HAVE
CONSISTENT LICENSING STANDARDS
TO SCALE THAT APPROACH, EVEN
THOUGH IT'S EMERGING ACROSS THE
COUNTRY AS A HIGHLY EFFECTIVE
PRACTICE TO IMPROVE OUTCOMES AND
REDUCE COSTS. SO FINANCE,
LICENSING, STAFFING FOR
INTENTIONAL, WE CAN ADDRESS THE
PATCHWORK ISSUE FOR NOT
INTENTIONAL. IT'S LIKELY TO BE
REPLICATED. BUT AGAIN, TO THE
POINT, I MEAN, A CRISIS
STABILIZATION UNIT WILL ONLY BE
REIMBURSED UP TO 23 HOURS. AND,
YOU KNOW, THE SAFETY NET HAS TO
LOOK COMPREHENSIVELY AT WHAT
HAPPENS AFTER THAT 23 HOURS OF
CRISIS STABILIZATION UNIT
SERVICE, RIGHT. WHERE DOES A
PERSON GO ON TO? AND I THINK THE
SORT OF POINT FROM THE SAFETY
NET STANDPOINT IS WE ALL HAVE TO
HOLD IT. ALL RIGHT. WE ALL HAVE
TO CONSIDER AND CARE ABOUT WHAT
HAPPENS FROM THE PREVENTION SIDE
ALL THE WAY THROUGH TO THE END
OF LIFE FOR THAT INDIVIDUAL. AND
IT CAN'T JUST BE ABOUT SORT OF
SHIFTING FROM ONE SYSTEM TO
ANOTHER OR FROM ONE SERVICE TO
ANOTHER, BUT REALLY SEEING HOW
WE CAN PULL TOGETHER THE FULL
CONTINUUM. AND I KNOW COUNTY
BEHAVIORAL HEALTH DIRECTORS,
WHEN THEY HAVE ALL OF THE PIECES
AND THE PARTS TO MAKE THE FLOW
WORK, THEY'RE REALLY GOOD AT
GETTING PEOPLE INTO THE RIGHT
LEVEL OF CARE THAT THEY NEED.
THE PROBLEM IS WE DON'T HAVE
ENOUGH OF THAT. AND I WOULD
ARGUE THAT, COUNTY BEHAVIORAL
HEALTH HAS A REALLY GOOD HANDLE
ON WHAT THE GAPS ARE FOR THEIR
UNIQUE SYSTEM, AND THE GAPS ARE
DIFFERENT DEPENDING ON WHO GOT
WHAT GRANT, WHERE. WELL, I WANT
TO THANK OUR PANEL, THIS HAS
BEEN A VERY, VERY, LIVELY
DISCUSSION, VERY INFORMATIVE,
EDUCATIONAL, IT IS EXTREMELY
DISHEARTENING HOW PATCHY OUR
CURRENT BEHAVIORAL HEALTH SYSTEM
IS. AND THESE ARE CONVERSATIONS
THAT WE NEED TO HAVE, BECAUSE IF
WE DON'T IN FIVE YEARS AND TEN
YEARS, WE'LL LOOK BACK AND WE'LL
SAY, WE PUT ALL OF THIS MONEY,
DEDICATED ALL OF THESE RESOURCES
, AND WE'RE STILL NOT IN THE
PLACE WHERE WE NEED TO BE. AND
SO WHEN YOU TALK ABOUT BEING
VERY INTENTIONAL ABOUT OUR NEXT
STEPS, I COULD NOT AGREE WITH
YOU MORE, IT'S STILL VERY MIND
BOGGLING HOW, ONE COUNTY WILL DO
SOMETHING OR CAN OFFER ONE
THING, AND THE NEXT COUNTY
CAN'T. AND IN THE REALM OF
HEALTH CARE, WE DON'T WE DON'T
DO THAT, THINGS ARE STANDARDIZED
. AND SO WE NEED TO REALLY WORK.
TO IMPROVE WHAT WE DO WITHIN OUR
BEHAVIORAL HEALTH SPACE, SO THAT
WE'RE NOT CONTINUOUSLY SAYING
THE SAME THINGS OVER AND OVER
AND OVER AGAIN, SO WE WILL
DEFINITELY BE CONTINUING THE
CONVERSATION WITH YOU ALL, NOT
ONLY FROM A COMMITTEE, BUT ALSO
FROM A PERSONAL LEVEL. THANK YOU
. STEPHANIE. AND JUST TO.
QUESTION. DOES SHE HAVE A
PRESENTATION? OKAY. ALL RIGHT.
IT IS MY TURN. OKAY. OH. SO YOU
SEE. YEAH. OKAY OKAY. SO WE WILL
NOW BRING UP, STEPHANIE WELCH
FROM THE CALIFORNIA HEALTH AND
HUMAN SERVICES AGENCY. AND TYLER
SAID WITH FROM THE DEPARTMENT OF
HEALTH CARE SERVICES. GOOD
AFTERNOON, THANK YOU SO MUCH FOR
HAVING US, DOCTOR WEBER, AND
INVITING US TO THE COMMITTEE. I
APOLOGIZE. WE WERE A LITTLE BIT
TARDY, IN FACT, I REALLY ENJOYED
GETTING TO LISTEN TO THE FIRST
PANEL FIRST SO THAT I CAN KIND
OF CHANGE MY REMARKS A LITTLE
BIT TO MAKE SURE THAT I TOUCH ON
SOME OF THE TOPICS THAT THEY
RAISED, I THINK I WAS STRUCK
BECAUSE THE FIRST TIME I EVER
WAS IN THIS PARTICULAR HEARING
ROOM WAS TO TESTIFY ON A B 88,
WHICH WAS THE ORIGINAL MENTAL
HEALTH PARITY BILL IN 1999, HERE
IN CALIFORNIA. AND I JUST
GRADUATED FROM UC DAVIS AND WAS
SOMEBODY WHO HAD TO BECOME A
MEDI-CAL PARTICIPANT IN ORDER TO
GET ACCESS TO THE BEHAVIORAL
HEALTH CARE THAT I NEEDED. I'M
MORE HOPEFUL ABOUT THE FACT THAT
IN THE LAST 25 YEARS, WE'VE MADE
INCREDIBLE PROGRESS, AND WE ARE
ON THE CUSP OF MAKING A MUCH
LARGER AMOUNT OF PROGRESS WITH A
CATALYST OF THINGS THAT I THINK
WE'RE GOING TO TALK ABOUT TODAY
IN WORKING IN THIS FIELD FOR THE
LAST 25 YEARS. IT'S LIKE ALMOST
A LITTLE BIT LIKE I CAN'T CATCH
MY BREATH IN THE LAST FOUR
YEARS, BEING IN THIS ROLE AS THE
DEPUTY SECRETARY OF BEHAVIORAL
HEALTH UNDER THIS
ADMINISTRATION, IT'S AN AWESOME
RESPONSIBILITY. AND MANY OF THE
POINTS THAT YOU MADE ABOUT
MAKING SURE THAT WE ARE MEETING
CERTAIN EXPECTATIONS, MEETING
OUTCOMES IS REALLY IMPORTANT.
BUT I THINK, FRANKLY, PART OF
THE PATCHWORK DISCUSSION THAT I
HEARD YOU DISCUSS OR THE PANEL
DISCUSSED BEFORE WE GOT HERE, IS
, UNFORTUNATELY, THE TOPIC OF
BEHAVIORAL HEALTH. PEOPLE
SUFFERING FROM MENTAL ILLNESS
AND SUBSTANCE USE DISORDERS
CONTINUES TO BE REALLY
STIGMATIZED. AND THE FACT THAT
WE HAD TO GO THROUGH A 20 YEAR
PERIOD TO KIND OF ACHIEVE BETTER
MENTAL HEALTH PARITY, TO HAVE
BEHAVIORAL HEALTH INCLUDED IN
OUR HEALTH ESSENTIAL HEALTH
BENEFITS, UNDER THE ACA AND THE
EXPANSION OF MEDICAID AND THAT
THAT REALLY ONLY HAPPENED ABOUT
A DECADE AGO, LESS THAN A DECADE
AGO, THAT WE, HAVE YET TO
REALIZE, I THINK SOME OF THE
MAJOR POLICY CHANGES THAT WE
HAVE. SO I WANTED TO START WITH
THAT, I APPRECIATED THE WORK
THAT THE LAO PUT TOGETHER WITH
THE WITH THE PARTICULAR BRIEF,
WE WORKED ON A SIMILAR BRIEF
LAST YEAR, REALLY TRYING TO,
LIFT UP MANY OF THE THINGS THAT
YOU HEARD THE PANEL BEFORE ME
TALK ABOUT THAT THERE SHOULDN'T
BE A CHOICE BETWEEN PREVENTION
AND ONGOING SUPPORT OF CARE, IN
FACT, WE MAKE THOSE CHOICES. WE
END UP WITH NOT HAVING FLOW IN
OUR SYSTEM, PEOPLE WITH
BEHAVIORAL HEALTH CONDITIONS, AS
YOU KNOW, AS, AS A PHYSICIAN, IN
DIFFERENT PARTS OF THEIR LIVES,
HAVE DIFFERENT LEVELS OF NEED.
AND PEOPLE HAVE TO BE ABLE TO
MOVE IN AND OUT OF THE SYSTEM,
WITH CARE COORDINATION IN ORDER
TO SWIFTLY GET A THEIR NEEDS MET
AND, AND TO HAVE A TAYLORIST OR
A TAILORED, INDIVIDUALIZED
SERVICE PLAN AND THAT IS
SOMETHING THAT WE ARE REALLY
WORKING TOWARDS, BUT FRANKLY, TO
ASK HOW WE THINK THE CONTINUUM
IS DOING IS REALLY A DIFFICULT
QUESTION. I DO WANT TO
UNDERSCORE, THE PANEL BEFORE, I
BELIEVE, REALLY TALKED ABOUT
ALMOST LIKE THESE THREE SYSTEMS
THAT WE HAVE THAT TREAT THE
BEHAVIORAL HEALTH CARE NEEDS OF
CALIFORNIANS. YOU HAVE PEOPLE
LIKE MYSELF WHO MAY HAVE
COMMERCIAL INSURANCE. I HAVE
ACCESS TO THAT COMMERCIAL
INSURANCE BECAUSE IT'S EMPLOYER
BASED INSURANCE. AND FRANKLY, MY
BEHAVIORAL HEALTH CONDITIONS CAN
BE MANAGED IN THAT SYSTEM. IF I
NEED A HIGHER LEVEL OF CARE, I
SHOULD BE ABLE TO GET IT IN THAT
SYSTEM UNDER MY COMMERCIAL
COVERAGE. AND MANY PEOPLE MAYBE
ARE NOT ABLE TO GET ACCESS TO
THAT IN AN ACCESSIBLE AND
ADEQUATE WAY, AND UNFORTUNATELY,
THE TIME BETWEEN WHEN A REALLY,
REALLY SIGNIFICANT BEHAVIORAL
HEALTH CRISIS OR THE ONSET OF A
MAJOR BEHAVIORAL HEALTH
CONDITION, AND WHEN SOMEONE MAY
NO LONGER BE ABLE TO BE, YOU
KNOW, GOING TO WORK AND BEING
ACTIVE AND BEING EMPLOYED IS NOT
NECESSARILY THAT LONG OF A TIME
FRAME. AND I THINK WE THINK THAT
THAT COULD NEVER HAPPEN TO US OR
THAT COULD NEVER HAPPEN TO A
LOVED ONE. BUT I BET YOU
EVERYONE IN THIS ROOM HAS
SOMEBODY THAT THEY CARE ABOUT,
INCLUDING POTENTIALLY THEMSELVES
, THAT HAS A PRETTY SERIOUS
BEHAVIORAL HEALTH CONDITION THAT
THEY'RE TRYING TO WORK HARD TO
SUPPORT THEM IN. SO THERE'S THAT
SYSTEM. AND THEN WE HAVE OUR
MEDICAID SYSTEM. AND I'M SITTING
HERE NEXT TO MY OUR STATE
MEDICAID DIRECTOR. I KNOW WE'LL
GO INTO DETAILS AROUND THAT. BUT
PEOPLE WHO HAVE MILD TO MODERATE
CONDITIONS SHOULD BE ABLE TO GET
SOME SUPPORTS TO HELP ADDRESS
THOSE NEEDS SO THAT THEY DON'T
HAVE CHRONIC CONDITIONS. OR IN
THE RARE CASES WHERE THAT IS THE
CASE, THEY CAN UTILIZE AND HAVE
ACCESS TO THE SPECIALTY SYSTEM
THAT MANAGES THOSE NEEDS FOR
MEDICAID BENEFICIARIES. BUT WHAT
I'M TRYING TO SAY IS THAT ALONG
THAT ENTIRE CONTINUUM, YOU HAVE
THREE DIFFERENT SYSTEMS THAT ALL
HAVE A ROLE TO PLAY TO KEEP
PEOPLE. WELL, AND, AND I THINK
WHAT WE'RE TRYING TO DO WITH THE
BULK OF MANY OF OUR INITIATIVES
UNDER THIS ADMINISTRATION AND IN
SUPPORT THE LEGISLATURE HAS BEEN
A TREMENDOUS SUPPORT IN ALL OF
THESE EFFORTS, IS TO SUPPORT
EACH SYSTEM, TO BE WORKING AT
ITS BEST AND TO BE ABLE TO HAVE
THE CAPACITY TO FILL, FULFILL
ITS OBLIGATION AND ITS
RESPONSIBILITIES. SO I THINK
SOME OF THE QUESTIONS THAT YOU
WERE THAT WERE BROUGHT TO US,
WERE TO TALK A LITTLE BIT ABOUT,
WAYS IN WHICH WE THINK THE
CONTINUUM COULD ALSO DO MORE TO
ADDRESS EQUITY, I WANT TO LIFT
UP THAT. I WOULD AGREE THAT
EQUITY IS MOST CERTAINLY A
CHALLENGE, THERE ARE A NUMBER OF
REASONS WHY, I THINK SOMETHING
THAT I DID NOT QUITE HEAR. MAYBE
MENTIONED BY THE, THE, THE PANEL
BEFORE US, IS THAT THE ACTUAL
EXPERIENCE OF BEHAVIORAL HEALTH
CARE CAN BE VERY TRAUMATIZING.
AND THE REALITY IS, IS THAT
BECAUSE OF THAT STIGMA OR MAYBE
THAT LACK OF KNOWLEDGE OF HOW TO
NAVIGATE THE SYSTEM, A LOT OF
PEOPLE DO NOT GET ANY HELP FOR
THEIR BEHAVIORAL HEALTH ISSUE
UNTIL THERE IS A CRISIS. AND
THAT CRISIS CAN BE VERY
TRAUMATIC THING. AND MAYBE THE
FIRST EXPERIENCE THAT SOMEONE
HAS IS ENGAGING WITH THE
BEHAVIORAL HEALTH SYSTEM IS NOT
A POSITIVE ONE. AND I THINK
THAT'S JUST A REALITY, AND SO I
THINK THERE'S CERTAIN
POPULATIONS WHO HAVE, WHO
HISTORICALLY HAVE BEEN
MARGINALIZED, DISCRIMINATED
AGAINST, WHO MAY HAVE AN
INHERENT DISTRUST OF A SYSTEM OR
HAVE ONLY EXPERIENCED ANY KIND
OF BEHAVIORAL HEALTH TREATMENT
BY INTERACTING WITH LAW
ENFORCEMENT, AND SO I THINK PART
OF WHAT WE REALLY NEED TO DO IS
FIGURE OUT HOW TO GO UPSTREAM
AND MAKE SURE THAT WE'RE
EDUCATING PEOPLE ABOUT HOW TO
GET EARLY ACCESS TO TREATMENT
AND TO BE HELP SEEKING. AND I'M
REALLY, PLEASED WITH SOME OF THE
WORK THAT OUR CHILDREN AND YOUTH
BEHAVIORAL HEALTH INITIATIVE IS
DOING, TO ENCOURAGE PEOPLE TO DO
THAT, I THINK ALSO, THERE WAS A
LOT OF DISCUSSION TODAY ABOUT
WORKFORCE. I THINK IT'S
ABSOLUTELY TIED TO ISSUES AROUND
EQUITY AND ACCESS, AS YOU HEARD,
THE PANEL BEFORE, WE DO NOT HAVE
A WORKFORCE THAT REPRESENTS WHAT
CALIFORNIANS LOOK LIKE, AND SO I
THINK WHAT WE'VE REALLY TRIED TO
DO WITH SOME OF OUR INITIATIVES
STARTING WITH THE CHILDREN AND
YOUTH INITIATIVE AND, AND VERY
PLEASED TO SAY THAT NOW THAT THE
VOTERS HAVE SUPPORTED PROP ONE,
THAT WE WILL HAVE A SUSTAINED
SOURCE OF WORKFORCE FUNDING. I
REALLY WANTED TO PICK UP ON WHAT
MISS CABRERA HAD MENTIONED
AROUND SLOTS. I'M A SOCIAL
WORKER BY TRAINING AND I
REMEMBER WHEN WE FIRST PASSED
THE CHILDREN AND YOUTH
BEHAVIORAL HEALTH INITIATIVE,
YOU KNOW, IT WAS ONE TIME MONEY
AT THE TIME. THIS WAS A COUPLE
OF YEARS AGO. AND THE SCHOOLS
WERE. YEAH, BUT HOW DO WE EXPAND
ALL THESE SLOTS OR BRING IN NEW
PROFESSORS, IF WE DON'T HAVE A
SUSTAINED FUNDING SOURCE FOR
THIS WORK AND WE'RE GOING TO BE
ABLE TO PROVIDE THAT SUSTAINED
FUNDING WORK SO THAT THE STATE
AND I THINK IT'S AN APPROPRIATE
STATE RESPONSIBILITY. CONTINUES
TO INVEST IN THE WORKFORCE OF
TOMORROW IN TERMS OF BEHAVIORAL
HEALTH AND ONE OF THOSE KIND OF
SUCCESS STORIES, I THINK WAS
REALLY EXCITED TO HAVE AN
OPPORTUNITY TO WORK INITIALLY ON
THE WELLNESS COACHES, WE HAVE
OVER A THOUSAND, I BELIEVE,
PROBABLY THE NUMBER RIGHT IN
FRONT OF ME WHO HAVE CREATED
ACCOUNTS TO SEEK CERTIFICATION,
THESE ARE, PEOPLE THAT WE'RE
HOPING ARE COMING FROM
COMMUNITIES THAT THEY WANT TO
TURN AROUND AND SERVE, THAT THEY
HAVE A PIPELINE IF THEY WANT TO
GET THEIR CERTIFICATION. AND
THEY LOVE DOING THIS WORK,
WORKING WITH YOUNG PEOPLE,
HELPING THEM NAVIGATE AND COACH
THEM THROUGH THEIR BEHAVIORAL
HEALTH CHALLENGES. MAYBE THEY
WANT TO GET THEIR BA IN SOCIAL
WORK OR GO AND BECOME A
PSYCHIATRIST, LIKE THE WOMAN WHO
WAS SITTING HERE NEXT TO ME. BUT
IT'S A WONDERFUL ENTREE TO NOT
ONLY CREATE, MORE OPPORTUNITIES
FOR YOUNG PEOPLE TO HAVE, LIKE A
LOW BARRIER ENTRY INTO OUR
WORKFORCE, BUT ALSO A PIPELINE
OF CONTINUING TO SKILL BUILD IF
THEY WANT TO STAY IN THIS
WORKFORCE, SO I DO BELIEVE THAT
BETWEEN, REALLY DOUBLING DOWN ON
OUR INVESTMENTS AND OUR
WORKFORCE CAPACITY, THAT WE WILL
START TO MAKE SOME PROGRESS
AROUND INCREASING MORE ACCESS,
BUT WE DO NEED TO CONTINUE TO
MAKE SURE THAT THINGS THAT ARE
NOT THE DOOR GETTING IN, THAT'S
CRISIS, ARE AVAILABLE TO
EVERYBODY IN THEIR COMMUNITIES,
AND THAT INCLUDES RAISING
AWARENESS, BUT ALSO DID WANT TO
SHARE SOME POSITIVE, NOTES ABOUT
THE WORK THAT WE'RE DOING IN THE
CRISIS CARE CONTINUUM, WITH OUR
FIRST ROUND OF OUR BEHAVIORAL
HEALTH INFRASTRUCTURE PROGRAM
DOLLARS, AT THIS POINT, WE'VE
BEEN ABLE TO SUPPORT COUNTIES IN
EITHER ENHANCING OR DEVELOPING
COMPLETELY NEW 300 PLUS MOBILE
CRISIS TEAMS, THESE MOBILE
CRISIS TEAMS, CAN BILL MEDI-CAL,
AND THEY ARE NON-LAW ENFORCEMENT
BASED. AND I DO THINK WHEN I
THINK ABOUT THAT, PILLARS OF
WHAT COULD BE A CATALYST FOR
SUSTAINED CHANGE IN HOW PEOPLE
EXPERIENCE AND ACCESS MENTAL
HEALTH CARE. THIS IS DEFINITELY
ONE OF THEM, I THINK ALSO WE'VE
BEEN ABLE TO ACCOMPLISH IN THE
LAST YEAR INCREASING OUR CALL
VOLUME TO 988, WHICH IS OUR,
CRISIS LINE, BY CLOSE TO 20. AND
SO WE HAVE AN IN-STATE CALL
ANSWER RATE OF 90, AND I THINK
WE'RE HOPEFUL AT SOME POINT, IN
PARTNERSHIP WITH OUR COUNTIES
AND OUR CONTRACTORS AND ALSO OUR
EMERGENCY PERSONNEL PARTNERS, TO
FIND WAYS IN WHICH HOPEFULLY,
LIKE YOU WERE MENTIONING, THE
WHOLE GOAL OF THIS IS TO PREVENT
THE CRISIS IN THE FIRST PLACE,
TO REFER SOMEBODY TO HELP AND
HAVE THAT HELP BE AVAILABLE, BUT
IF THAT CRISIS DOES OCCUR, HOW
CAN IT BE, A LESS TRAUMATIC
EXPERIENCE AND SO THAT THE
ENTREE INTO RECEIVING SERVICES
IS ONE IN WHICH PEOPLE FEEL
COMFORTABLE, AND POSITIVE AND
HOPEFUL THAT THEY'RE GOING TO
GET WELL, I THINK ONE OF THE
LAST THINGS I REALLY WANT TO
LIFT UP, AND I BELIEVE THAT MR.
SADWITH WILL DO THIS AS WELL,
IS, WHEN I THINK ABOUT THE
CRISIS CONTINUUM AND THE
PATCHWORK, WE'VE NEVER HAD A
SOURCE, FIRST, OF ALL, WE HAD WE
RECEIVED THE RESOURCES FOR
BISHOP FOR THE BEHAVIORAL HEALTH
INFRASTRUCTURE PROGRAM, $2.2
BILLION, WHILE WE'D HAD THINGS
BEFORE, MAYBE LIKE NO PLACE LIKE
HOME THERE JUST SIMPLY WASN'T AN
ABILITY TO INVEST IN THE
PUBLICLY FUNDED MENTAL HEALTH
AND SUBSTANCE USE TREATMENT
SYSTEM, AT LEAST IN MY
RECOLLECTION IN THE LAST 25
YEARS, REALLY IN A SUBSTANTIAL
WAY. AND, I KNOW I'VE TALKED TO
MISS MISS CAPRARA ABOUT THIS,
BUT IT'S REALLY HARD WHEN YOU'RE
WHEN YOU'RE THE PUBLIC SAFETY
NET TO HAVE ENOUGH RESOURCES TO,
LIKE, BUILD A BUILDING, THAT'S
VERY, VERY DIFFICULT TO DO. AND
SO I DO FEEL LIKE IT'LL BE A
REALLY CRITICAL GAME CHANGER.
AND, YOU KNOW, WE'VE BEEN ABLE
TO SO FAR. I FIND MY NOTES HERE.
LET'S SEE, WE'VE BEEN ABLE TO SO
FAR IN OUR BEHAVIORAL HEALTH
CONTINUUM INFRASTRUCTURE
PROGRAM. EXPAND OUTPATIENT
CAPACITY BY OVER 280,000 SLOTS,
AND THAT AND WE'VE ALSO BEEN
ABLE TO CREATE 20 OVER 2600
INPATIENT AND RESIDENTIAL BEDS.
NOW, ARE THEY ALL BUILT YET? NO,
BECAUSE IT TAKES A WHILE TO
BUILD THOSE THINGS AND TO BUILD
CAPACITY. BUT I DO THINK THAT,
IT'S SUBSTANTIALLY MORE THAN
WE'VE EVER HAD COLLECTIVELY IN
THE PAST, EVEN THOUGH COUNTY'S
WORKED REALLY HARD IN THE IN THE
PAST TO USE MHSA DOLLARS TO DO
THINGS LIKE MHA MHSA HOUSING,
THIS REALLY IS, A DOUBLE DOWN
INVESTMENT ON MAKING SURE THAT
THERE IS WHAT, WHAT WE REFER TO
AS FLOW IN THE SYSTEM, IF I
NEED, TO BE HOSPITALIZED BECAUSE
I'VE HAD A SUICIDE ATTEMPT OR
SELF-INJURIOUS BEHAVIOR, THAT
THERE IS A PLACE WHERE I CAN GO
AFTER THAT, THAT'S AVAILABLE
BEALL OR I'M READY TO GET
TREATMENT FOR MY SUBSTANCE USE
DISORDER. AND THERE'S A
RESIDENTIAL BED THAT'S AVAILABLE
IN MY COMMUNITY. AND SO WHILE
IT'LL TAKE US YEARS, I MEAN, TO
BE HONEST, TO REALIZE THAT IN
SOME CASES, THE MONEY IS THERE.
AND WITH THE PROPOSITION
PASSING, AND GIVING US THE
ABILITY TO HAVE ANOTHER $4.4
BILLION, ESSENTIALLY MORE THAN
DOUBLING THE INVESTMENTS THAT
WE'VE MADE. SO FAR, I THINK WE
HAVE A CHANCE AT REALLY BUILDING
OUT A CONTINUUM THAT CAN MEET
PEOPLE WHERE THEY'RE WHERE
THEY'RE AT, AND SUPPORT THEM TO
GET TO THE LEAST, RESTRICTIVE
LEVEL OF CARE. THE LAST POINT I
WANT TO MAKE, AND I DO FEEL LIKE
I TOTALLY WENT OFF MY SCRIPT,
BUT, THE LAST POINT, THE LAST
POINT, I REALLY WANT TO MAKE IS
THAT, YOU KNOW, WITH, WITH ALL
OF OUR VARIOUS INITIATIVES,
INCLUDING THINGS LIKE EVERYTHING
FROM BEHAVIORAL HEALTH PARITY TO
THE CARE ACT, I THINK THE INTENT
IS TO GET AT SOMEONE EARLY
BEFORE THEY ARE IN THOSE VERY
RESTRICTIVE SETTINGS, CARE, FOR
EXAMPLE, WAS DESIGNED TO PREVENT
PEOPLE FROM HAVING TO BE
INCARCERATED OR HAVING TO BE
CONSERVED. AND ONE OF THE BRIGHT
SILVER LININGS IN CARE THAT
WE'VE SEEN SO FAR WITH OUR EARLY
IMPLEMENTATION COUNTIES, IS THAT
REALLY LOOKING AT TWO THINGS?
HOW DO YOU STEP SOMEBODY OFF OF
CONSERVATORSHIP, THROUGH CARE,
OR HOW DO YOU DIVERT SOMEBODY
FROM, A LONGER CONSERVATORSHIP
AFTER A TEMPORARY
CONSERVATORSHIP? SO AND ONE OF
THE THINGS THAT WE HAVE TO HAVE
IN ORDER TO, TO, DO THAT IS
PROVIDE, RESIDENTIAL SUPPORT.
AND SO IT KIND OF CAME UP A
COUPLE DIFFERENT TIMES. WE'VE
DISCUSSED IT A DIFFERENT A FEW
DIFFERENT WAYS. WE MIGHT REFER
TO IT AS ENRICHED RESIDENTIAL,
THIS IS THAT SMALL GROUP OF
INDIVIDUALS WHO HAVE VERY
CHRONIC, SERIOUS BEHAVIORAL
HEALTH CONDITIONS, AND THEY NEED
MORE INTENSIVE SUPPORTS. AND SO
THEY MAY NOT BE SUCCESSFUL IN,
IN INDEPENDENT, PERMANENT
SUPPORTIVE HOUSING OR MAYBE THEY
JUST NEED TO STEP UP INTO
SOMETHING THAT'S A HIGHER LEVEL
OF CARE. AND WHEN THEY'RE DOING
WELL, STEP DOWN. THAT'S THE FLOW
IN IN THE SYSTEM, THAT BELONGS
IN OUR HOUSING CONTINUUM, SO TO
SPEAK, THAT BLURRED LINE
SOMETIMES BETWEEN OUR HOUSING
CONTINUUM AND OUR CARE
CONTINUUM, BECAUSE SOME PEOPLE,
NEED RESIDENTIAL CARE AND THEY
NEED IT FOR A SIGNIFICANT AMOUNT
OF TIME, I THINK I'LL JUST
CLOSE. I HAVE A MOTHER WHO'S IN
HER 80S, AND SHE HAD TO HAVE
DOUBLE KNEE SURGERY AND, I WAS
NOT CAPABLE OF TAKING CARE OF
HER, BUT SHE WAS ABLE TO GO TO A
REHABILITATION HOSPITAL, FOR, I
THINK, 30 TO 45 DAYS. I CAN'T
REMEMBER THE EXACT TIMING, AND
GET REALLY INTENSIVE THERAPY.
AND SHE WAS ABLE TO COME HOME
AND WALK UP AND DOWN HER STAIRS
INTO HER APARTMENT. AND I THINK
THAT'S FOR A SMALLER SUBSET OF
OUR POPULATION. IF WE'RE ABLE TO
DO THAT FOR THEM, THEN THEY DO
NOT NEED TO BE IN THESE LOCKED,
HIGH LEVELS OF CARE, AND SO I'M
REALLY EXCITED THAT HOPEFULLY
WITH BABY PROP ONE AND SOME OF
THE OTHER EXCITING THINGS I'M
SURE TYLER'S GOING TO TALK ABOUT
THAT, OUR TOOLS AND RESOURCES
THAT WE ARE EXPLORING AND
IMPLEMENTING WITH OUR MEDICAID
PROGRAM, THAT WE'RE GOING TO BE
ABLE TO HELP PEOPLE LIKE THAT
AND THAT KIND OF CYCLE OF HAVING
TO, USE REALLY, REALLY HIGH
INTENSITY SERVICES IS BROKEN
BECAUSE PEOPLE ARE ACTUALLY ABLE
TO GO AND STEP DOWN TO KIND OF
LIKE A RECOVERY OR
REHABILITATION TYPE OF A SERVICE
BEFORE THEY THEN SEEK TO LIVE
FULLY INDEPENDENTLY IN THEIR OWN
HOUSING. SO AND I'M HAPPY TO
TAKE QUESTIONS. I THINK YOU
MIGHT HAVE HAD A COUPLE OF OTHER
SPECIFIC QUESTIONS I MAY OR MAY
NOT HAVE TOUCHED ON, BUT WE CAN.
I WANT TO MAKE SURE I HAVE
PLENTY OF TIME FOR MR. SADWITH
TO MAKE SOME COMMENTS AND CAN
TAKE YOUR QUESTIONS. THANK YOU.
ALL RIGHT. GOOD AFTERNOON. MY
NAME IS TYLER SADWITH, AND I'M
THE STATE MEDICAID DIRECTOR AT
THE DEPARTMENT OF HEALTH CARE
SERVICES. THANK YOU FOR THE
OPPORTUNITY TO PARTICIPATE IN
THIS HEARING. IT'S BEEN A REALLY
, INVIGORATING AND SORT OF
CANDID CONVERSATION, AS TO SORT
OF HOW FRAGMENTED OUR BEHAVIORAL
HEALTH, FINANCING AND SERVICE
DELIVERY SYSTEM IS AND SORT OF
HOW WE GOT HERE, IT FEELS LIKE
WE'RE MAKING, SEVERAL DECADES OF
SORT OF NEGLECTED FUNDING
INVESTMENTS AND POLICY REFORMS,
WITHIN THE SPAN OF A FEW YEARS,
AND SO I THINK WE'RE HAPPY TO
SORT OF SHARE SOME OF THOSE KEY
POLICIES AND STRATEGIES THAT
WE'RE UNDERTAKING TO STRENGTHEN
THE BEHAVIORAL HEALTH CONTINUUM,
AND HIGHLIGHT HOW WE'RE
ATTRACTING THE IMPACT OF THOSE,
ACROSS THE STATE, SO I'LL SHARE
JUST A FEW KEY POINTS ABOUT HOW
WE PLAN TO DO THAT WITH THE
BEHAVIORAL HEALTH INFRASTRUCTURE
AND HOUSING PROGRAMS THAT WERE
TOUCHED UPON, AS WELL AS THE
CHILDREN AND YOUTH BEHAVIORAL
HEALTH INITIATIVE AND SOME OF
OUR, REFORMS UNDER CAL AIM AND
CONNECT, SO THROUGH THE
BEHAVIORAL HEALTH CONTINUUM
INFRASTRUCTURE PROGRAM, OR BCP,
THE DEPARTMENT WILL AWARD $2.2
BILLION TO REALLY EXPAND, BRICK
AND MORTAR INFRASTRUCTURE ACROSS
THE ENTIRE CONTINUUM OF CARE, TO
DATE, WE HAVE AWARDED, $1.7
BILLION IN FUNDING, THIS
INCLUDES, AS STEPHANIE MENTIONED
, AND, 48 CITIES, COUNTIES AND
TRIBAL ENTITIES THAT ARE NOW
EXPANDING 300 NEW OR ENHANCED
MOBILE CRISIS RESPONSE TEAMS
ACROSS CALIFORNIA SO THAT
INDIVIDUALS CAN BE, ENGAGED WHEN
THEY'RE EXPERIENCING A CRISIS BY
THE HUMAN SERVICES SYSTEM AND
NOT THE LAW ENFORCEMENT SYSTEM,
WE'VE AWARDED OVER $1.4 BILLION
IN FUNDING THAT WILL DIRECTLY
LEAD TO OVER 2600 INPATIENT AND
RESIDENTIAL BEDS AND 280,000
OUTPATIENT TREATMENT SLOTS. AND
A CONDITION FOR RECEIVING THESE
FUNDS IS THAT EVERY PROJECT MUST
PARTICIPATE IN MEDI-CAL AND
OPERATE FOR 30 YEARS. THE
DEPARTMENT ALSO RECOGNIZING
RECOGNIZES AS THE PANELISTS HAVE
TOUCHED UPON, THAT HOUSING IS
REALLY A KEY PART OF THE
CONTINUUM. IT'S HARD TO GET WELL
AND STAY WELL AND DISCHARGE FROM
INPATIENT AND RESIDENTIAL
SETTINGS. IF YOU DON'T HAVE A
SUPPORTIVE HOUSING ENVIRONMENT,
THE DEPARTMENT IS DISTRIBUTING
$1.5 BILLION IN GRANT FUNDING TO
COUNTY BEHAVIORAL HEALTH
AGENCIES AND TRIBAL ENTITIES
THROUGH THE BEHAVIORAL HEALTH
BRIDGE HOUSING PROGRAM, WHICH IS
DESIGNED TO MEET THE IMMEDIATE
HOUSING NEEDS OF CALIFORNIANS,
WITH, WHO ARE UNSHELTERED AND
HAVE SIGNIFICANT BEHAVIORAL
HEALTH CONDITIONS. WE'VE BEGUN
AWARDING $907 MILLION TO 53
COUNTIES AND $30 MILLION TO NINE
TRIBAL ENTITIES. I THINK THE
LAST FUNDING INVESTMENT THAT
I'LL QUICKLY TOUCH ON IS THE
CHILDREN AND YOUTH BEHAVIORAL
HEALTH INITIATIVE, WHICH IS A
MULTI YEAR FOR POINT $7 BILLION
INITIATIVE THAT REALLY TAKES A
WHOLE CHILD APPROACH TO ADDRESS
THE CONTRIBUTING FACTORS THAT
CAN LEAD TO THE MENTAL HEALTH
AND WELL-BEING OF OUR CHILDREN
AND YOUTH, TO DATE, THE
DEPARTMENT HAS AWARDED, NEARLY
$250 MILLION IN GRANT FUNDING TO
ORGANIZATIONS ACROSS ALL 58
COUNTIES TO IMPROVE ACCESS TO
THE EVIDENCE BASED SERVICES AS
WELL AS COMMUNITY DEFINED
PRACTICES THAT ARE REALLY
IMPORTANT TO SORT OF STANDARDIZE
AND SCALE UP ACROSS THE STATE.
FROM SORT OF THE POCKETS WHERE
THEY EXIST TODAY. SO IN ADDITION
TO TRACKING SORT OF THE OUTCOMES
THAT THESE INVESTMENTS WILL,
ACHIEVE IN TERMS OF EXPANDED
CAPACITY AND INFRASTRUCTURE, THE
DEPARTMENT IS MONITORING HOW
THESE INVESTMENTS WILL IMPACT
AND INCREASE ACCESS TO CARE FOR
MEMBERS. WE HAVE SEVERAL
DIFFERENT SORT OF TOOLS OR,
VEHICLES FOR MONITORING ACCESS
TO CARE, ONE OF THEM IS MEDI-CAL
BEHAVIORAL HEALTH. NETWORK
ADEQUACY DATA AND REQUIREMENTS,
THIS, THIS IS THESE ARE SORT OF
FEDERALLY MANDATED AND STATE
MANDATED STANDARDS THAT COUNTIES
MUST MEET, THERE ARE SPECIFIC
REQUIREMENTS RELATED TO PROVIDER
NETWORK CAPACITY, SUCH AS
PROVIDER TO MEMBER RATIOS LIKE
PSYCHIATRY, LIKE CERTAIN NUMBER
OF PSYCHIATRISTS FOR EVERY ADULT
IN THE NETWORK AND EVERY CHILD
IN YOUTH IN THE NETWORK, THERE
ARE TIME AND DISTANCE STANDARDS
SO THAT SERVICES CAN BE
AVAILABLE NEAR WHERE MEMBERS
LIVE AND THERE ARE TIMELY ACCESS
STANDARDS TO ENSURE MEDI-CAL
MEMBERS ARE OFFERED INITIAL
APPOINTMENTS AND FOLLOW UP
APPOINTMENTS IN A TIMELY MANNER.
WE HAVE A NUMBER OF, INDEPENDENT
EVALUATION AND INDEPENDENT
REVIEW, TECHNICAL REVIEW REPORTS
THAT ARE CONDUCTED ANNUALLY, AND
I'LL TOUCH ON THOSE IN JUST A
MOMENT. I THINK ONE OTHER SORT
OF KEY PLATFORM FOR MONITORING,
THE IMPACT ON THESE INVESTMENTS
IN SERVICE CAPACITY AND SERVICE
UTILIZATION WILL BE THROUGH NEW,
SORT OF ACCOUNTABILITY.
COMPONENTS OF PROPOSITION ONE,
WHICH REQUIRES THE DEPARTMENT TO
COLLECT, BEHAVIORAL HEALTH
OUTCOMES, ACCOUNTABILITY AND
TRANSPARENCY REPORTS FROM COUNTY
BEHAVIORAL HEALTH AGENCIES EVERY
YEAR AND TO DEVELOP NEW
BEHAVIORAL HEALTH PERFORMANCE
MEASURES. THE COMMITTEE ASKED
QUESTIONS ABOUT GAPS, GAPS THAT
EXIST IN THE CONTINUUM, GAPS
THAT REMAIN DESPITE THESE
INVESTMENTS. SO IN ADDITION TO
THESE ACCESS MONITORING TOOLS,
THE DEPARTMENT, ISSUED A REPORT
IN 2022, WHICH REALLY IS A
STATEWIDE NEEDS ASSESSMENT FOR
THE BEHAVIORAL HEALTH CONTINUUM,
THE PURPOSE OF THE REPORT WAS TO
SERVE, SORT OF A DATA INFORMED
FOUNDATION FOR SOME OF THESE
MAJOR INITIATIVES THAT WE'RE
IMPLEMENTING. SO SOME OF THE
GAPS THAT WERE SPECIFICALLY
IDENTIFIED IN THE NEEDS
ASSESSMENT REALLY, CENTERED
AROUND CRISIS SERVICES, WHICH
WERE TOUCHED ON TODAY. TWO
THIRDS OF COUNTIES REPORTED
INSUFFICIENT PATIENT CAPACITY
FOR CRISIS STABILIZATION UNITS,
OVER HALF OF COUNTIES REPORTED A
LACK OF CRISIS. RESIDENTIAL
TREATMENT FACILITIES. AND, OVER
THREE QUARTERS OF COUNTIES
LACKED SOBERING CENTERS. AND WE
ALSO KNOW FROM MEDI-CAL NETWORK
ADEQUACY DATA THAT RESIDENTIAL
TREATMENT FOR MENTAL HEALTH AND
SUBSTANCE USE DISORDER FOR
YOUTH, IN PARTICULAR, IS A KEY
GAP IN CARE, UNDER THE
INVESTMENTS IN B CHIP, WE'VE
BEGUN TO CLOSE THOSE GAPS, WE'VE
INCREASED CRISIS STABILIZATION
UNITS ACROSS THE STATE BY 26, WE
HAVE, LAUNCHED OR SUPPORTED THE
LAUNCH OF 11 NEW CHILDREN'S
CRISIS RESIDENTIAL PROGRAMS.
WE'VE INCREASED SOBERING CENTER
CAPACITY BY 72% AND ADOLESCENT
SUBSTANCE USE DISORDER TREATMENT
CAPACITY BY 20. IN IN ADDITION
TO THESE SORT OF BRICK AND
MORTAR PHYSICAL EXPANSIONS, THE
DEPARTMENT IS TAKING KEY STEPS
TO REALLY STANDARDIZE AND SCALE
THE AVAILABILITY OF EVIDENCE
BASED SERVICE MODELS IN MEDI-CAL
THAT WE KNOW FROM RESEARCH ARE
PROVEN TO IMPROVE OUTCOMES FOR
PATIENTS, IMPROVE QUALITY OF
LIFE, REDUCE EMERGENCY
DEPARTMENT UTILIZATION, REDUCE
HOSPITALIZATION, AND REDUCE
INVOLVEMENT WITH LAW
ENFORCEMENT, SO THESE ARE SOME
OF THE SERVICES THAT THE PRIOR
PANEL TOUCHED ON SUCH AS
COORDINATED SPECIALTY CARE FOR
FIRST EPISODE PSYCHOSIS, UNDER
OUR CONNECT WAIVER, WE WILL
PROVIDE A NEW DEDICATED
REIMBURSEMENT MODEL TO SUPPORT
COUNTIES WITH DELIVERING THAT
SERVICE AND OTHER SERVICES LIKE
ASSERTIVE COMMUNITY TREATMENT
AND SUPPORTED EMPLOYMENT AND
CLUBHOUSE SERVICES THAT WE KNOW
ARE, YOU KNOW, REALLY NEEDED TO
SHORE UP THAT EARLY INTERVENTION
OUTPATIENT PART OF THE CONTINUUM
SO THAT WE'VE REDUCED THE NEED
FOR INPATIENT SERVICES. WE'RE
PROVIDING NOT ONLY DEDICATED
FUNDING AND SERVICE MODELS FOR
COVERING THAT IN MEDI-CAL, BUT
ALSO EXTENSIVE TECHNICAL
ASSISTANCE RESOURCES, FOR
COUNTIES AND FOR PROVIDERS TO
CONDUCT FIDELITY ASSESSMENTS AND
RECEIVE COACHING FOR CLINICAL
PRACTICE TRANSFORMATION SO THAT
THE WORKFORCE CAN ACTUALLY HAVE
THE TOOLS THEY NEED TO DELIVER
THESE SERVICES. WITH FIDELITY,
IN TERMS OF WORKFORCE UNDER
BEACH CONNECT, WE'RE ALSO
PROPOSING TO, DRAW DOWN
SIGNIFICANTLY LEVERAGED FEDERAL
FUNDING, SO THAT WE HAVE, OVER A
FIVE YEAR PERIOD, $2.4 BILLION
IN NEW WORKFORCE DEVELOPMENT
FUNDING THAT WOULD GO TOWARDS
EXPANDING, THE TYPES OF TRAINING
PROGRAMS THAT THE LAST PANEL
TALKED ABOUT AND ENSURING THAT
THE WORKFORCE, IS CULTURALLY AND
LINGUISTICALLY COMMENSURATE WITH
CALIFORNIANS, RECEIVING SERVICES
AND THAT THE WORKFORCE LOOKS
LIKE, THE PATIENTS SHOWING UP IN
THE OFFICES. THE COMMITTEE ASKED
SEVERAL QUESTIONS ABOUT, DELAY
IN FUNDING AND WHY IT'S SO SLOW
TO SPEND MONEY, WITH, UNDER THE
B CHIP PROGRAM. AS STEPHANIE
MENTIONED, IT DOES TAKE TIME TO
BUILD NEW BUILDINGS, THE TYPE OF
CONSTRUCTION THAT AWARDEES ARE
PURSUING, WHETHER IT'S A REAL
ESTATE ACQUISITION, A RENOVATION
OF AN EXISTING BUILDING, OR SORT
OF PURCHASING A NEW GROUNDS AND,
AND BREAKING GROUNDS, IT CAN
REALLY REQUIRE VARIOUS LEVELS OF
LOCAL PERMITTING AND ZONING AND
COUNTY APPROVALS. WE'VE SEEN
PROJECTS THAT EVEN OBTAIN ALL OF
THOSE REQUISITE APPROVALS, LOSE
THEIR SITE LOCATION DUE TO LOCAL
OPPOSITION, INCLUDING NIMBY
DYNAMICS, WE'VE ALSO SEEN COUNTY
PROJECTS BE SIGNIFICANTLY
DELAYED DUE TO EXTENDED
TIMELINES THAT COUNTY BOARD OF
SUPERVISORS HAVE FOR APPROVING
PROJECTS, AS WELL AS, WORKFORCE
SHORTAGES IN THE CONSTRUCTION
INDUSTRY THAT LEAD TO
SIGNIFICANT DELAYS IN
CONSTRUCTION, WE'RE PROVIDING
TECHNICAL ASSISTANCE TO COUNTIES
TO HELP THEM WITH NAVIGATE THE
COMPLEX REAL ESTATE ACQUISITION
AND HOUSING DEVELOPMENT
PROCESSES. THE COMMITTEE ASKED
ABOUT, HOW WE ARE LOOKING ON THE
HORIZON AT DEMOGRAPHY AND
CHANGES IN CALIFORNIA'S
POPULATION AND HOW WE'RE
PLANNING FOR THOSE TRENDS. I
THINK, WHEN I THINK ABOUT THAT
QUESTION, I THINK RIGHT NOW, AND
I THINK ABOUT EQUITY, I THINK
ABOUT HOW DO WE MAKE SURE THAT
SERVICES AT THIS MOMENT IN TIME,
IN THE NEXT FEW YEARS, LOOK AT,
ARE CAPABLE OF MEETING THE NEEDS
AND SUCCESSFULLY ENGAGING WITH
CALIFORNIANS TODAY, NOT JUST 30
YEARS OUT, SO THAT IS REALLY A
CORNERSTONE OF A NUMBER OF
EFFORTS IN CAL AIM, AS AS
PANELISTS HAVE MENTIONED, WE'RE
ADDING COVERAGE FOR NEW SERVICES
LIKE COMMUNITY HEALTH WORKER
SERVICES. WE HAVE COVERED PEER
SUPPORT SPECIALISTS, AS PART OF
SAIBAI, WE'RE PARTNERING WITH
HCCI TO DEVELOP WELLNESS
COACHES. AND RIGHT NOW WE'RE
NEGOTIATING WITH OUR FEDERAL
PARTNERS TO SECURE APPROVAL FOR
TRADITIONAL HEALERS. THAT WOULD
BE A MEDI-CAL BENEFIT FOR, OUR
AMERICAN INDIAN AND ALASKA
NATIVE POPULATIONS, THESE ARE
REALLY, REALLY DESIGNED TO
ENSURE THAT THESE ARE TRUSTED
MESSENGERS PROVIDING THAT
ENGAGEMENT, ESTABLISHING THAT
THERAPEUTIC ALLIANCE, BEING IN
THE COMMUNITY, SEEING PEOPLE IN
PERSON OUTSIDE OF THE CLINIC,
SETTING, OUTSIDE OF THE FOUR
WALLS. THIS IS WHERE HEALTH CARE
NEEDS TO BE BECAUSE THIS IS
WHERE PEOPLE ARE. LOOKING AHEAD
TO THE FUTURE THOUGH, WE KNOW
THAT BY 2030, OVER 10 MILLION
CALIFORNIANS WILL BE AN OLDER
ADULT, MAKING UP ONE QUARTER OF
THE POPULATION. THE DEPARTMENT
HAS PARTNERED WITH THE
CALIFORNIA DEPARTMENT OF AGING
TO PROMOTE BEHAVIORAL HEALTH
RESOURCES. THE DEPARTMENT
CONVENED MANAGED MEDICARE
ADVANTAGE PLANS TO DISCUSS
OPPORTUNITIES AND STRATEGIES TO
IMPROVE ACCESS TO BEHAVIORAL
HEALTH CARE SERVICES FOR
MEDICARE MEMBERS. AND WE'VE ALSO
PARTNERED WITH CMS, OUR FEDERAL
PARTNERS, TO PROMOTE AWARENESS
OF NEW MEDICARE BENEFITS IN THE
PROGRAM, WE WERE ASKED TO TOUCH
ON, SORT OF HOW WE DIFFERENTIATE
THE STATE'S ROLE FROM THE
COUNTY'S ROLE IN THE BEHAVIORAL
HEALTH SERVICE DELIVERY SYSTEM,
I THINK OF IT AS SORT OF A DUAL
ROLE, ONE OF OVERSIGHT AND
REGULATION AND ONE OF
PARTNERSHIP AND TECHNICAL
ASSISTANCE. THE DEPARTMENT IS
THE STATE MEDICAID AGENCY. SO WE
OPERATE MEDI-CAL, WHICH IS IN
ITSELF A STATE FEDERAL
PARTNERSHIP. IT'S CALIFORNIA'S
MEDICAID PROGRAM. WE DESIGN IT
WITHIN CERTAIN FEDERAL
PARAMETERS, AND OUR BEHAVIORAL
HEALTH BENEFITS, THE SPECIALTY
BEHAVIORAL HEALTH BENEFITS
REALLY ARE DELIVERED THROUGH
COUNTY BEHAVIORAL HEALTH
AGENCIES. WE ALSO PURCHASE NON
SPECIALTY MENTAL HEALTH SERVICES
FROM MEDI-CAL MANAGED CARE PLANS
. AND WE'VE BEEN TAKING STEPS TO
INCREASE, THE WAYS MEMBERS CAN
BE APPROPRIATELY REFERRED TO AND
ACCESS NON-SPECIALTY MENTAL
HEALTH SERVICES SO THAT THE
SAFETY NET ISN'T ENTIRELY
RESPONSIBLE FOR ALL BEHAVIORAL
HEALTH CARE IN THE STATE. THE
DEPARTMENT ALSO HAS OTHER
FUNCTIONS FACILITY LICENSURE AND
CERTIFICATION. THÀNH, BUT
COUNTIES ARE ULTIMATELY
RESPONSIBLE FOR PROVIDING
BEHAVIOR HEALTH CARE TO
RESIDENTS. THEY HAVE A PATCHWORK
OF FUNDING. 1991 REALIGNMENT
2011 REALIGNMENT FUNDS. FORMERLY
THE MENTAL HEALTH SERVICES ACT,
WHICH WAS RECAST AS THE
BEHAVIORAL HEALTH SERVICES ACT
THROUGH PROPOSITION ONE. THROUGH
MEDI-CAL, AND THROUGH FEDERAL
GRANT PROGRAMS THAT WE
ADMINISTER TO OUR COUNTIES,
COUNTY IS CONTRACT WITH
PROVIDERS. SOMETIMES COUNTIES
OPERATE SERVICES DIRECTLY.
SOMETIMES COUNTIES CONTRACT WITH
COMMUNITY BASED PROVIDERS. SO
PROVIDERS REALLY ARE KEY ACTORS
AND KEY PARTNERS IN THE HEALTH
CARE DELIVERY SYSTEM. I THINK IN
A IN ADDITION TO OUR ROLE AS A
PAYER AND A REGULATOR, WE WORK
HAND IN HAND WITH COUNTIES TO
PROVIDE TECHNICAL ASSISTANCE TO
HELP SCALE INNOVATION AND TO
REALLY, ENSURE THAT THOSE THESE
INCREDIBLE AND ONCE IN A
GENERATION FUNDING OPPORTUNITIES
ARE DESIGNED IN A WAY THAT CAN
BE SUCCESSFUL ON THE GROUND. SO
WE LISTEN AND WE LEARN FROM OUR
COUNTIES TO MAKE SURE THAT THE
PROGRAMS WERE ADMINISTERING ARE
GOING TO BE EFFECTIVE FOR THEM.
THE COMMITTEE REQUESTED A
DISCUSSION ON OUTCOME AND
PERFORMANCE MEASURES, SO I'M
HAPPY TO VERY BRIEFLY TOUCH ON
HOW WE MEASURE, ACCESS MÁS AND
QUALITY AND OUTCOMES FOR
BEHAVIORAL HEALTH SERVICES. WE
HAVE A COMPREHENSIVE FRAMEWORK
FOR MEASURING AND MONITORING
QUALITY OF CARE AND HEALTH
OUTCOMES FOR MEDI-CAL MEMBERS
AND CONSUMERS. THE DEPARTMENT,
PUBLISHED A COMPREHENSIVE
QUALITY STRATEGY WHICH LAYS OUT
HEALTH EQUITY GOALS AND SUPPORTS
A TEN YEAR VISION FOR THE
MEDI-CAL PROGRAM AND WITHIN THE
QUALITY STRATEGY, THERE ARE A
SPECIFIC SET OF CORE QUALITY
METRICS THAT COUNTIES REPORT
ANNUALLY RELATED TO BEHAVIORAL
HEALTH. SO THESE ARE SORT OF
STANDARD, KIEDIS OR MANAGED CARE
PLAN METRICS THAT THAT CMS USES
THAT LOOK AT THINGS LIKE THE
RATES OF FOLLOW UP, FOR
BEHAVIORAL HEALTH CARE AFTER AN
INDIVIDUAL VISITS, THE EMERGENCY
DEPARTMENT, RATES OF FOLLOW UP
MENTAL HEALTH CARE AFTER AN
INPATIENT, HOSPITALIZATION FOR
PSYCHIATRIC CARE AND THE USE OF
EVIDENCE BASED PRACTICES LIKE
MEDICATIONS FOR ADDICTION
TREATMENT FOR SCHIZOPHRENIA AND
FOR DEPRESSION. SO THESE ARE
MEASURES THAT RIGHT NOW WE ARE
REPORTING ON, AND, IN THE FUTURE
THERE WILL BE, CERTAIN
EXPECTATIONS AND TARGETS THAT
COUNTIES MEET, PERFORMANCE
THRESHOLDS ON THE MEASURES AND
MAY FACE PENALTIES IF THEY DON'T
MEET THEM. THESE ARE REPORTED
PUBLICLY. WE ALSO HAVE A NUMBER
OF DASHBOARDS THAT WE REPORT
THAT SHOW C OTHER MEASURES AND
SERVICE UTILIZATION. WE HAVE
INDEPENDENT QUALITY REVIEWS THAT
WE PUBLISH EVERY YEAR. AND WE
HAVE INDEPENDENT EVALUATIONS OF
OUR DRUG MEDI-CAL ORGANIZED
DELIVERY SYSTEM, WHICH PROVIDES
SUBSTANCE USE BENEFITS FOR 97%
OF MEDI-CAL. TO WRAP UP, I THINK
PERHAPS MOST IMPORTANTLY, WE, WE
USE ANNUAL MEMBER EXPERIENCE
SURVEYS FOR BOTH MENTAL HEALTH
AND SUBSTANCE USE DISORDER. AND
THE DEPARTMENT, BROADLY
SPEAKING, IS INVESTING IN
CREATING NEW WAYS FOR US TO MEET
WITH MEDI-CAL MEMBERS DIRECTLY
AND HEAR FROM THEM. NOT JUST
ADVOCATES, NOT JUST ADVOCACY
ORGANIZATION, BUT MEMBERS WHO
RECEIVE SERVICES. SO WE ARE
DOING THIS AND BEHAVIORAL HEALTH
MAY NOT BE SURPRISING AS A TOP A
TOP PRIORITY FOR OUR MEMBERS. SO
I'LL CLOSE JUST BY BY LOOKING
LOOKING AHEAD. WE'VE BEEN ASKED
TO SPEAK TO A COUPLE OF
QUESTIONS ABOUT THE
IMPLEMENTATION OF PROPOSITION
ONE, I WOULD EMPHASIZE THAT WE
ARE NOW LAUNCHING AN EXTENSIVE
PLANNING PROCESS TO PREPARE US
AND TO PREPARE COUNTIES AND
PROVIDERS TO IMPLEMENT THE
VARIOUS PROVISIONS OF THE LAW.
THE MAJORITY OF THE PROVISIONS
GO INTO EFFECT IN JULY 2026. SO
ABOUT A LITTLE OVER TWO YEARS
OUT, THERE WILL BE A TREMENDOUS
AMOUNT OF CONSULTATION AND
STAKEHOLDER ENGAGEMENT, AND SORT
OF ROLL UP YOUR SLEEVE PLANNING
CONVERSATIONS THAT WILL OCCUR ON
A REGULAR BASIS TO HELP US
COLLECTIVELY PREPARE FOR A
SUCCESSFUL IMPLEMENTATION. AND
THERE WAS ONE SPECIFIC QUESTION
RELATED TO BOND FUNDING THAT
WILL BE MADE AVAILABLE VIA THE
BISHOP PROGRAM, AS AUTHORIZED BY
PROPOSITION ONE. THE DEPARTMENT
HAS BEGUN BEGUN ENGAGING
STAKEHOLDERS ON THE BONDS. WE
HAD A PUBLIC LISTENING SESSION
LAST FRIDAY ON THE 19TH ON THE
PORTION OF THE BOND FUNDING,
WHICH REPRESENTS $4.4 BILLION,
THAT WILL BE ADMINISTERED
THROUGH THE B CHIP PROGRAM THAT
WE'VE TOUCHED ON, THE
ADMINISTRATION IS EVALUATING
COSTS AND ANALYZING PROGRAM
SPECIFICS. AND WE WILL SHARE
MORE DURING THE MAY REVISION. SO
I KNOW THAT WAS A LOT OF
INFORMATION, APPRECIATE YOUR
PATIENCE AND HAPPY TO ANSWER ANY
QUESTIONS. THANK YOU BOTH SO
MUCH FOR BEING HERE. I ALSO WANT
TO ACKNOWLEDGE THAT, NATHANIEL
WILLIAMS IS HERE FROM THE
DEPARTMENT OF FINANCE. IF WE
NEED ANY QUESTIONS ANSWERED. SO
THANK YOU SO MUCH. JUST A FEW
QUESTIONS. SO WHEN YOU WERE
REFERRING EARLIER ABOUT, YOU
KNOW, THE INCREASE IN INPATIENT
BEDS AND SOME OF THE THINGS THAT
WE'RE DOING WHEN WE'RE LOOKING
AT AT IMPLEMENTING DIFFERENT
THINGS, EVEN WITH PROP ONE, ARE
WE GOING TO BE IMPLEMENTING THEM
EQUALLY ACROSS THE STATE, OR IS
EACH COUNTY GOING TO HAVE TO
ESSENTIALLY FIGHT FOR THESE
FUNDS AND THESE PROGRAMS? YEAH.
SO, THE B CHIP PROGRAM, WHICH IS
WHAT THE BOND IS BASED ON, IT'S
BASICALLY A CONTINUATION OF THAT
PROGRAM WITH MORE RESOURCES, IS
A COMPETITIVE PROGRAM IN WHICH
COUNTIES, CITIES, NONPROFITS FOR
PROFITS AND THE TRIBAL SET-ASIDE
ARE ALL ELIGIBLE TO APPLY FOR
THE FUNDS FOR DIFFERENT
PROJECTS. ONE OF THE THINGS THAT
HAPPENED IN B CHIP THAT I HOPE,
WE CAN, WE CAN REMIND PEOPLE OF
IS THAT SEVERAL COUNTIES AND
ACTUALLY SEVERAL TRIBES AS WELL,
IN ROUND TWO OF B CHIP DID A
COMMUNITY PLANNING GRANT. AND
REALLY WHAT WE WERE HOPING THAT
THOSE WOULD REFLECT IS WHAT ARE
THE NEEDS OF YOUR COMMUNITY. AS
I WOULD REALLY UNDERSCORE WHAT
THE PREVIOUS PANEL SAID,
COUNTIES LOOK VERY, VERY
DIFFERENT. AND HAVE, YOU KNOW,
DIFFERENT. THEY HAVE A THEY HAVE
DIFFERENT POPULATIONS THAT
THEY'RE SERVING, BUT THEY ALSO
JUST HAVE DIFFERENT
INFRASTRUCTURE. AND SO I THINK
THOUGH MOST I WELL, I THINK IT
WAS AT LEAST OVER 30, MISS
CABRERA MIGHT KNOW THE EXACT
NUMBER, BUT THE MAJORITY OF
COUNTIES DID DO THAT COMMUNITY,
THAT PLANNING PROCESS TO REALLY
DO THEIR OWN ASSESSMENT OF WHERE
THEY FELT THE NEED WAS. I THINK
THERE HAVE BEEN SOME OTHER
EFFORTS BY BOTH RAN THAT WAS
COMMISSIONED BY THE COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION TO REALLY TRY TO
ASSESS AS WELL, WHERE DID THEY
NEED TO MAKE THESE INVESTMENTS,
AND THEN LASTLY, I WOULD SAY
THAT THE GUIDANCE THAT WE'VE PUT
OUT IS PRETTY ROBUST FOR THE B
CHIP PROGRAM IN 2022 AS AS TYLER
HAD MENTIONED, WE DID A VERY
COMPREHENSIVE BEHAVIORAL HEALTH
NEEDS ASSESSMENT, TO REALLY TRY
TO ON A STATE WIDE BASIS,
IDENTIFY PRIORITIES FOR THE
INVESTMENTS. I THINK I'M NOT
GOING TO REMEMBER ALL OF THEM
OFF THE TOP OF MY HEAD. BUT,
CERTAINLY YOUTH AND YOUNG ADULTS
WAS ONE, ACROSS THE BOARD
SUBSTANCE USE DISORDER.
POPULATIONS WHO WERE JUSTICE
IMPACTED, AND I'M SURE I'M
FORGETTING SOME OTHER TYLER THAT
YOU MIGHT REMEMBER, BUT WE DID
DO A COMPREHENSIVE ASSESSMENT
WORKING WITH MANATT TO TRY TO
REALLY, ON A STATEWIDE BASIS,
UNDERSTAND, WHAT SOME OF THE
NEEDS WERE. THE OTHER THING TO
ADD, NØ JUST THE IN IN B CHIP,
WHICH WILL BE THE SORT OF THE
VEHICLE FOR DISPENSING THE BOND
FUNDS, WE USE THE NEEDS
ASSESSMENT AS SORT OF A DATA
INFORMED BASIS FOR IDENTIFYING
WHERE WHERE ARE THE NEEDS, WHERE
ARE THE GAPS TO AVOID
UNNECESSARY INVESTMENTS AND
OVERCONCENTRATION AND EVERY
COUNTY, EVERY, EVERY APPLICANT
THAT WAS NOT A COUNTY APPLICANT
REQUIRED A LETTER OF SUPPORT
FROM THE COUNTY, SO HAD TO FIT
INTO THE LOCAL ECOSYSTEM. THANK
YOU FOR THAT. YOU KNOW, I REALLY
HOPE THAT THIS DOES NOT
PERPETUATE THE PATCHWORK THAT WE
SEE, SO MY HOPE IS THAT AT THE
STATE LEVEL, WE HAVE SOME BASIC
GUIDELINES AND SOME BASIC
STANDARDS BASED ON NATIONAL
EVIDENCE. AND I'M COMING FROM A
HEALTH CARE PERSPECTIVE OF HOW
CERTAIN THINGS SHOULD BE
MANAGED. AND THEN TAKE THAT TO
SEE WHICH COUNTIES ARE DOING IT
AND WHICH COUNTIES AREN'T, AND
FILLING IN THOSE GAPS, AND NOT
JUST NECESSARILY ALLOWING THE
COUNTIES TO DIRECT THE FUNDS,
BECAUSE THEN WHAT WE'RE GOING TO
CONTINUE TO SEE IS YOU CAN GET
ONE THING IN SAN DIEGO COUNTY
AND ANOTHER IN ORANGE COUNTY AND
ANOTHER IN LA COUNTY, AND THAT'S
NOT REALLY HELPING OUR PATIENTS,
SO I HOPE THAT WE WOULD LEARN
THE LESSONS FROM WHAT WE'VE BEEN
DOING INCORRECTLY FOR THE LAST
20 PLUS YEARS TO, BETTER UTILIZE
THIS, THESE FUNDS THAT OUR
VOTERS HAVE, GRACIOUSLY GIVEN US
THROUGH PROPOSITION ONE. MY
OTHER QUESTION ACTUALLY COMES
FROM A, A FELLOW ASSEMBLY MEMBER
WHO'S NOT ON THIS COMMITTEE, BUT
VERY INTERESTED IN THIS
PARTICULAR, AREA. THE QUESTION
IS, DO OUR CRISIS INTERVENTION
APPROACH, INCLUDING MOBILE
CRISIS CENTERS, HAVE TRAINING
AND BEST PRACTICE INTERVENTIONS
THAT INVOLVE INDIVIDUALS ON THE
AUTISM SPECTRUM? YES. QUESTIONS
THAT I FORGOT TO ANSWER, SO I
APOLOGIZE, YES. LET ME START
WITH THE MEDI-CAL MOBILE CRISIS
BENEFIT. SO MOBILE CRISIS TEAMS
AND THERE WAS GUIDANCE THAT WE
CAN CERTAINLY SEND YOU SO THAT
THE MEMBER HAS THAT GUIDANCE AND
DETAIL, THAT WAS PUBLISHED, WAS
THAT EARLIER THIS YEAR MIGHT
HAVE BEEN LATE LAST YEAR, WHERE
MOBILE CRISIS TEAMS ARE TO
RESPOND TO A BENEFICIARY WITH
INTELLECTUAL OR DEVELOPMENTAL
DISABILITIES TO ENSURE THAT
THERE ARE NATURAL SUPPORTS. SO,
SO WORKING AS BEST AS THEY CAN,
IF APPROPRIATE, WITH FAMILY
CAREGIVERS, PERSONAL ATTENDANTS,
TO THE EXTENT POSSIBLE, MOBILE
CRISIS TEAMS ARE ENCOURAGED TO
INCLUDE A TEAM MEMBER WITH ID
EXPERTISE, ON THEIR ACTUAL TEAM,
AND THEN MEMBERS OF MOBILE
CRISIS TEAMS ARE ALSO REQUIRED
TO REQUIRED TO PARTICIPATE IN
TRAINING ON HOW TO RESPOND
APPROPRIATELY IN CRISIS
SITUATIONS WITH INDIVIDUALS WHO
ARE LIVING WITH INTELLECTUAL AND
DEVELOPMENTAL DISABILITIES. SO
SO THAT INCLUDES AUTISM SPECTRUM
DISORDER, CO-OCCURS OF ID AND
MENTAL HEALTH CONDITIONS, WHICH
IS A PERVASIVE AND ACTUALLY IS A
POPULATION WHO OFTEN EXPERIENCES
THIS KIND OF CRISIS, AND
COUNTIES ARE ALSO SO REQUIRED TO
DEVELOP MOUS WITH REGIONAL
CENTERS TO COORDINATE SERVICES
GENERALLY. AND THIS WOULD BE ONE
AREA IN WHICH THEY COULD COULD
LOOK INTO BETTER COORDINATION.
AND THEN I JUST ALSO WANTED TO
SHARE THAT AS PART OF OUR STATE
985 YEAR IMPLEMENTATION PLANNING
PROCESS, WE ARE WORKING WITH
THE, THE STATE DEVELOPMENTAL
DISABILITIES COUNCIL. THEY ARE
REPRESENTED ON THAT ADVISORY
COMMITTEE, BUT ALSO WILL HAVE A
PORTION OF THAT FIVE YEAR
IMPLEMENTATION PLAN WITH
SPECIFIC RECOMMENDATIONS IN THIS
SPACE, NOT JUST FOR MOBILE
CRISIS, BUT FOR IMPROVING CRISIS
RESPONSE OVERALL, WITH THIS
POPULATION. THÀNH. THANK YOU.
AND IF YOU CAN PROVIDE THAT
INFORMATION, I'M SURE THAT THE
ASSEMBLY MEMBER WOULD BE GREATLY
APPRECIATIVE OF THAT, AND WITH
THAT, I'M GOING TO THANK OUR
SECOND PANEL AND OPEN IT UP FOR
ANY COMMENTS FROM THE PUBLIC.
THANK YOU, MADAM CHAIR, FOR THIS
IMPORTANT HEARING ON THIS VERY
IMPORTANT TOPIC, MARK FAROOQ,
CALIFORNIA HOSPITAL ASSOCIATION
THÀNH JUST WANT TO MAKE A FEW
COMMENTS, FIRST, RELATED TO THE
IMPLEMENTATION OF PROPOSITION
ONE, WE URGE THE LEGISLATURE AND
DCS TO FOCUS ON COUNTY
TRANSPARENCY WITH THEIR
COMMUNITIES AS AS WE MOVE
FORWARD ON IMPLEMENTATION AND
THAT BEFORE MAKING CRITICAL
DECISIONS ABOUT HOW TO ADAPT
CURRENT SPENDING, LOCAL
COMMUNITY MEMBERS AND
STAKEHOLDERS SHOULD BE GIVEN
CLEAR AND DETAILED INFORMATION
THÀNH FROM THEIR COUNTIES ABOUT
CURRENT AND PROJECTED REVENUES
THE COUNTIES RECEIVED TO PROVIDE
MENTAL HEALTH AND SUBSTANCE USE
SERVICES, AND CURRENT SPENDING
ON EXISTING MENTAL HEALTH AND
SUBSTANCE USE DISORDER SERVICES,
AND UP TO DATE INFORMATION ABOUT
THE QUALITY AND ACCESSIBILITY OF
CARE BEING PROVIDED. WE REALLY
THINK IT'S IMPORTANT THAT THIS
BE A OPEN STAKEHOLDER PROCESS,
ALONGSIDE LOCAL PROVIDERS,
FAMILIES AND CONSUMERS, SO THAT
THIS IS NOT SOMETHING THAT
DECISIONS ARE NOT BEING MADE
BEHIND CLOSED DOORS, THAT IT'S
AN OPEN PROCESS AND THEN
FINALLY, JUST WANTED TO MENTION,
WE'VE OBVIOUSLY HEARD IN THIS
HEARING TODAY ABOUT THE SEVERE
LACK OF, OF BEHAVIORAL HEALTH
AND SUBSTANCE USE, SUBSTANCE
ABUSE TREATMENT CAPACITY, YOU
KNOW, THERE WAS A RECENT REPORT
FROM RAND CORPORATION THAT FOUND
A SHORTFALL OF 8000 BEHAVIORAL
HEALTH BEDS AT THE ACUTE,
SUBACUTE AND RESIDENTIAL LEVEL
HERE IN CALIFORNIA, AND WE HAVE
24 COUNTIES. I THINK THIS WAS
MENTIONED EARLIER WHERE
RESIDENTS HAVE NO IN COUNTY
ACCESS TO INPATIENT PSYCHIATRIC
HOSPITAL SERVICES AT ALL.
OVERALL, ON ANY GIVEN DAY, 550
PSYCHIATRIC PATIENTS LANGUISH IN
HOSPITALS WHEN THEY NO LONGER
NEED TO BE THERE, AND THEY STAY
ON AVERAGE, CLOSE TO ONE MONTH
IN THE HOSPITAL, EVEN WHEN
THEY'RE READY FOR DISCHARGE. THE
PRIMARY REASON FOR THIS IS THAT
COUNTIES AND HEALTH PLANS LACK
ADEQUATE NETWORKS OF STEP DOWN
CARE OPTIONS, PLACES FOR PEOPLE
TO GO ONCE THEIR MOST ACUTE
SYMPTOMS ARE STABLE. FOR MANY
INDIVIDUALS, SIMPLY DISCHARGING
BACK HOME IS NOT AN OPTION
BECAUSE THEY MAY LACK THE
SUPPORTS TO STAY STABLE AND
HEALTHY, OR THEIR INCOMES ARE
TOO LOW TO LIVE SOMEPLACE
PERMANENT AND SAFE, DISCHARGE
DELAYS MAKE IT HARDER FOR
PATIENTS TO RECOVER IT INCREASE
HEALTH CARE COSTS AND STRAINS
HOSPITAL CAPACITY. TODAY,
SERVICES SUCH AS CRISIS
STABILIZATION, INPATIENT
PSYCHIATRIC HOSPITAL SERVICES,
CRISIS RESIDENTIAL AND
RESIDENTIAL TREATMENTS AREN'T
EVEN COUNTED IN THE STATE'S
NETWORK. ADEQUACY REVIEWS FOR
MEDI-CAL MENTAL HEALTH SYSTEM
CAPACITY. WE CONTEND THAT THE
STATE SHOULD BOLSTER ITS
MEDI-CAL AND COMMERCIAL HEALTH
PLAN MONITORING TO ENSURE THAT
THERE ARE ADEQUATE NETWORKS OF
INPATIENT AND POST HOSPITAL CARE
OPTIONS AVAILABLE TO PEOPLE
LIVING WITH SERIOUS MENTAL
ILLNESS. THANK YOU. GOOD
AFTERNOON, MADAM CHAIR,
RICHARDSON DAVIS WITH THE
CALIFORNIA COUNCIL OF COMMUNITY
BEHAVIORAL HEALTH AGENCIES, JUST
WANTED TO SAY THAT WE APPRECIATE
THE CONVERSATION AND WANTED TO
HIGHLIGHT A COUPLE OF THINGS
THAT ARE RELATED TO OUR MEMBERS,
LIKE THE MOBILE CRISIS SERVICES,
WORKFORCE STABILITY IN RELATION
TO MEDI-CAL REIMBURSEMENT RATES,
AND ALSO, OUR PROVIDERS, THEY
SERVE A DIVERSE SPECTRUM WITHIN
THE BEHAVIORAL HEALTH CONTINUUM,
SO WE JUST WANT TO SUPPORT ANY
STANDARDIZATION IN THE
STREAMLINING OF SUPPORTS OF
THESE SERVICES SO THEY CAN
PROVIDE TO THEIR COMMUNITIES.
THANK YOU. GOOD AFTERNOON, MADAM
CHAIR. JOE LEE ONODERA WITH THE
CALIFORNIA STATE ASSOCIATION OF
COUNTIES. REPRESENTING ALL 58
COUNTIES. I JUST WANTED TO THANK
YOU. AND THE PANEL FOR TODAY'S
DISCUSSION, AND THEN JUST WANTED
TO SAY I LOOK FORWARD TO WORKING
WITH YOU, YOUR COMMITTEE AND THE
ADMINISTRATION, ON ALL OF THESE
BEHAVIORAL HEALTH INITIATIVES,
INCLUDING PROPOSITION ONE. I
UNDERSTAND THERE'S A LOT OF WORK
AHEAD. THANK YOU. GOOD
AFTERNOON. JENNIFER ALI WITH THE
, CALIFORNIA OPIOID MAINTENANCE
PROVIDERS REPRESENTING ABOUT 120
LICENSED NON NARCOTIC TREATMENT
PROGRAMS IN CALIFORNIA, TREATING
ABOUT 40,000 PATIENTS, WE
APPRECIATE THE THOUGHTFUL
DISCUSSION TODAY AND JUST WANTED
TO TOUCH ON ONE ITEM IN THE
AGENDA, WHICH WAS THE BUDGET
CHANGE PROPOSAL REGARDING OUR
LICENSING FEE TRANSFER. AND WE
JUST WANT TO ACKNOWLEDGE THE
HARD WORK THAT DHS DOES WITH OUR
PROVIDERS ON A REGULAR BASIS AND
HOW MUCH WE APPRECIATE THAT, BUT
ALSO THAT WE, ALSO APPRECIATE
THAT THE TRANSFER RATHER THAN
THE INCREASE IN FEES AS MY
MEMBERS, YOU KNOW, FACE A LOT
OF, ISSUES AT IDENTIFYING AND
HIRING STAFF IN SUCH A
COMPETITIVE WAGE MARKET TIME. SO
THANK YOU VERY MUCH. WELL, I
WANT TO ONCE AGAIN, THANK
EVERYONE WHO PARTICIPATED IN THE
PANEL, EVERYONE WHO GAVE PUBLIC
COMMENT, WE ARE DEFINITELY, AT A
CROSSROADS WITH ALL OF THE
RESOURCES THAT WE HAVE BEEN
GRANTED. SO I'M HOPEFUL THAT
THOSE OF US IN THE LEGISLATURE,
BUT ALSO ALL OF THE DEPARTMENTS
AND THE COUNTIES, WERE LISTENING
IN AND REALLY UNDERSTAND THE
CHALLENGES THAT WE'VE HAD IN OUR
BEHAVIORAL HEALTH SPACE, AND THE
WAY IN WHICH IT HAS BEEN,
CREATED AS FAR AS THIS
PATCHWORK, WHICH AT THE END OF
THE DAY HAS NOT REALLY HELPED
OUR RESIDENTS. AND SO FROM A
LEGISLATOR STANDPOINT, WE
DEFINITELY NEED TO HAVE MORE
OVERSIGHT, MORE ACCOUNTABILITY,
AND MORE TRANSPARENCY TO
ACTUALLY ENSURE THAT THE DOLLARS
, THAT WE HAVE ALLOTTED IS
ACTUALLY BEING SPENT IN A WAY
THAT IS HELPING ALL CALIFORNIANS
AND THAT IT SHOULDN'T MATTER,
REALLY, WHAT COUNTY YOU LIVE IN,
BUT THAT WE ARE USING EVIDENCE
BASED METHODS TO TREAT SOME OF
OUR MOST VULNERABLE IN THIS
SPACE, REGARDLESS OF WHERE THEY
LIVE, REGARDLESS OF HOW MUCH
THEY MAKE, REGARDLESS OF THEIR
RACE, GENDER, ETHNICITY, THAT IS
OUR RESPONSIBILITY. AND THAT IS
DEFINITELY SOMETHING THAT WE
WILL BE WATCHING VERY CLOSELY.
SO ONCE AGAIN, THANK YOU. AND
THIS HEARING IS ADJOURNED.
ANYWAY.