ADOPTED
MINUTES
Mental Health Board
Tuesday, February
10, 2010
City Hall, Room
278
BOARD MEMBERS PRESENT: James Shaye Keys, Secretary; Susan
McIntyre, ; Mary Ann Jones, PhD; M. Lara Siazon Arguelles; Tom Purvis; Errol
Wishom; Iviana Williams; Lisa Williams and Virginia Wright.
BOARD MEMBERS ON LEAVE: None
BOARD MEMBERS ABSENT: James L. McGhee, Chair, Officer Kelly
Dunn; Njoroge Tho-Biaz, M.A.
OTHERS PRESENT: Helynna Brooke (MHB Executive
Director); Loy M. Proffitt (MHB Administrator); Kavoos Bassiri, RAMS; Nan Dame,
Behavioral Health Information Systems Manager; Frank Isidro, Information System
Consumer Advocate; Maria Iyog-O’Malley, Mental Health Services Act (MHSA)
Program Coordinator; Fancher Larson, Antonio Morgan, Mental Health Association
(MHA-SF); Michelle Schutz, MHA-SF; Eric P. Scott, MHA-SF; and five other members
of the public.
CALL TO ORDER
The
meeting was called to order at 6:39 PM by Mr. Keys.
ROLL CALL
Ms.
Brooke called the roll.
AGENDA CHANGES
Mr.
Keys announced that Dr. Cabaj was running late, so the meeting would start with
the MHSA Public Hearing, Item 2.0.
ITEM 1.0 DIRECTORS REPORT
1.1 Discussion regarding Community
Behavioral Health Services Department Report, a report on the activities and
operations of Community Behavioral Health Services, including budget, planning,
policy, and programs and services.
Mr.
Keys: “Dr. Robert Cabaj, Director of Community Behavioral Health Services
(CBHS) will give the Director’s report.”
Dr.
Cabaj reviewed the monthly director’s report as attached.
Ms.
McIntyre: “Does
Mr.
Cabaj: “I have been in charge of disaster planning and services in
Ms.
Wright: “Is the
Dr.
Cabaj: “Yes.”
Dr.
Jones: “I am concerned about the MHSA voter initiative which California
Governor Arnold Schwarzenegger would like to raid again.”
Dr.
Cabaj: “The MHSA voter initiative touches people at many levels, and I am
strongly against the governor’s action.”
Mr.
Purvis: “The National Alliance on Mental Illness of San Francisco (NAMI-SF) is very
much opposing the Governor’s action as well.
We have used facebook and twitter to disseminate information and bring about
public awareness.”
Over
View of Community Behavioral Health Services
Dr.
Cabaj: “Years ago we were blessed by
The
In-patient
adult psychiatry did not generate revenue for the City. We have lost psychiatric beds at
The
Dore Urgent Care Center is an alternative to the Psychiatric Emergency Services
(PES). Dore is able to receive people
who are 5150’d but cannot hold people involuntarily. We have roughly fifty-two
beds at Acute Diversion Units where patients can get about two weeks of care.
We
replaced the day treatment for adults with the wellness recovery and
socialization program because this program is more cost efficient.”
Dr.
Jones: “The clubhouse model works well with people with schizophrenia while the
drop-in model is good for those with mood disorders.”
Dr.
Cabaj: “We are looking for new sites to have more drop-in capability.”
Ms.
McIntyre: “Can you elaborate about the day treatment program for adults?”
Dr.
Cabaj: “We found day treatment programs to not work well for people, but case management
seems to work better. There are over 500
practitioners participating in a private provider network (PPN). Many people do not see the importance of prevention,
but we believe prevention is very important!
The MHSA has helped with prevention funding, the Early Psychosis Project
is an example. We are not cutting mental
health services. It is more of squeezing
and shifting services around. Primary
care can take on mental health care.
Dr.
Jones: “How does the Mental Health Plan work with respect to being accepted at
private hospitals?”
Dr.
Cabaj: “The Mental Health Plan was originally designed for MediCal
clients. That is why the
Another
thing we do is the integration of mental health with primary care. We contract out, for example, to
Mr.
Wishom: “I worked at SFGH’s in-patient units for about a year. It seemed that there were more empty beds”
Dr.
Cabaj: “The whole unit was closed down.
One unit was changed from acute to non-acute status.”
Ms.
Arguelles: “When the Mental Health Rehabilitation Facility (MHRF)
reduced psychiatric beds, my daughter was sent to the
Dr.
Cabaj: “The placement team authorizes the levels of care based on various
criteria that sometimes shift people outside of
The
cost of real-estate property in
Ms.
Wright: “How long can a patient with mental illness stay before getting kicked
out of a hospital?”
Dr.
Cabaj: “The average length of stay at places like St. Francis is about seven
days and SFGH is about eleven days. With
modern medications, people with mental illness can be stabilized in about five
days.”
1.2 Public Comment
Mr.
Morgan: Mr. Antonio Morgan is from the Mental Health Association (MHA-SF). He mentioned that the Mobile Crisis Treatment
Team saved his life. He said when people
with mental illness are put in jail the City and County San Francisco usually ends
up spending more money anyway. He also talked
about indigents in distress often having difficulty getting access to mental
health services.
Dr.
Cabaj: “Community Behavior Health Services includes public policies to advocate
for our system of care. We try to give
people risk assessment within twenty-four hours. Our Treatment Access Program (TAP) at 1380
Howard is a one-stop program to reduce the run around. Community Behavior Health Services (CBHS)
recognizes that mental illnesses affect all of us directly and indirectly.
Not
only do people with mental illness often get stigmatized and discriminated
against, not only do the loved ones feel helpless to stand by and watch their
family or friends suffer an active psychosis but also often untreated psychosis
drives mental ill people to behave in such a way that these people often become
homeless or get incarcerated. I am very
much committed to improving mental health care for all San Franciscans.”
Monthly Director’s Report
February
10, 2010
1. Mental Health Service Act (MHSA) Update
INNOVATION
COMPONENT THREE YEAR PROGRAM AND EXPENDITURE PLAN
The Innovation Component Three Year Program and
Expenditure Plan is now posted on the San Francisco MHSA website for a period
of 30 days, from February 9, 2010 to March 10, 2010. The link is: http://www.sfdph.org/dph/comupg/oservices/mentalHlth/MHSA/mnu30-DayNotice.asp. Please
e-mail your comments to: prop63@sfdph.org or send to: Community Behavioral Health Services, Mental
Health Services Act, 1380 Howard Street, 2nd Floor, San Francisco, CA 94103;
Attention: Marlo Simmons.
FY10-11
ANNUAL PLAN UPDATE
MHSA
regulation requires counties to submit an annual plan update every fiscal year
for each component that has an approved Three Year Program and Expenditure
Plan. For
MHSA ADVISORY COMMITTEE MEETINGS
The Mental Health Services Act Advisory Committee meets bi-monthly from 3-5 pm, alternating between advisory meetings and community forums. The next scheduled meetings are as follows:
Wednesday, February 17, 2010 Wednesday,
April 21, 2010
Community Forum Advisory
Meeting
UCSF Citywide & Community Focus Center
Upcoming Training
Thursday, February 11, 2010- Friday, February 12, 2010
Into the Eye of the Storm: Essentials of Disaster Mental Health
Presenter: Diane Myers, R.N., M.S.N., C.T.S.
90th
Mental
health professionals are increasingly called upon to respond to large-scale,
community-wide disasters. This workshop will provide participants with
essential knowledge and skills for intervening effectively with mental health
needs in the complex and intense aftermath of disaster. Topics will include
types of disaster, trauma caused by disaster, risk groups, and phases of
disaster recovery. Clinicians will learn how disaster mental health
interventions differ from psychotherapy, and will learn effective mental health
interventions to be used in a variety of disaster settings and time phases.
Organizational aspects of disaster response will be discussed, with an emphasis
on how mental health professionals can become part of an organized and
integrated community response effort. Self-care and prevention of secondary
traumatization for disaster mental health professionals will be emphasized.
Thursday, February 18, 2010-Friday, February 19, 2010
CISM: Group Crisis Intervention A Curriculum of the International
Critical Incident Stress Foundation (ICISF)
Presenter: Diane Myers, R.N., M.S.N., C.T.S.
90th
Fire, floods,
earthquakes, transportation accidents, workplace and community violence,
terrorism—mental health professionals are increasingly called upon to respond
to disasters and their traumatic impacts.
This workshop will provide participants with the knowledge and skills
essential to providing Critical Incident Stress Management (CISM) services in
the complex and intense aftermath of trauma and disaster. CISM is a form of early intervention called
psychological first aid. It is not psychotherapy. Through lecture and readings,
participants will learn the history of traumatic stress and psychological first
aid interventions in response to traumatic events; examples of events that can
cause traumatic stress reactions; the human stress response; and basic concepts
of traumatic stress. They will learn an
overview of CISM interventions, research on the effectiveness of psychological
first aid, and best practices in early intervention with trauma. Through
viewing videotapes, observing demonstrations of interventions, participating in
group discussion, and practicing skills in small groups, participants will gain
experience in using the group intervention of demobilization, crisis management
briefing, Critical Incident Stress Debriefing (CISD), and defusing.
For more information regarding
these trainings, please contact Norman Aleman, CBHS
Training Coordinator at 415-255-3553 or email norman.aleman@sfdph.org
_____________________________________________________________________________
Past issues of the CBHS Monthly Director’s Report are available at: http://www.sfdph.org/dph/comupg/oservices/mentalHlth/CBHS/CBHSdirRpts.asp
To receive this Monthly Report via e-mail, please e-mail richelle-lynn.mojica@sfdph.org
Item 2.0 MENTAL HEALTH SERVICE ACT UPDATES
AND PUBLIC HEARINGS
2.1 Public Hearing: MHSA Information
Technology Component and Technological Needs Project Proposals.
(The presentation is attached)
Mr.
Keys: “As part of the Mental Health Services Act (MHSA), the Mental Health
Board is required to hold public hearings of all new plans or updates. Community Behavioral Health Services has just
completed the Information Technology Component and Technological Needs Project
Proposals. The team will present the
proposal then respond to MHB member questions and comments, and then the public
will have an opportunity to make comments.”
Ms.
Iyog-O’Malley: “Good evening. I am the
MHSA Program Coordinator. This Board has
heard all five components of MHSA: Community Support and Services (CSS) in
2005, Workforce Education and Development (WET) in 2008, Prevention and Early
Intervention in 2008, Capital Facilities in 2009, now Information Technology
(IT) in 2010.
Mr.
Isidro: “I would like to mention that Ms. Nan Dame and I are co-authors of the
project. Ms. Dame who is the Behavioral
Health Information Systems Manager will elaborate the electronic records and
patient records section.
Please
follow along with me on the power point presentation. MHSA IT goals are to increase client and family
member empowerment and to modernize and transform mental health services.
The
planning process started in September 2008 and ended about six month latter. All meetings were open to the public, and
there was an average of 23 members of the public attending. Our first meeting started in January 2009
with 26 voting members on the MHSA-IT Planning Committee. Of the 26 total, there were 12 consumers, 14
community based providers including 2 alternates. The Mental Health Board of San Francisco
staff member, Loy Proffitt was on the MHSA-IT Planning Committee.
To
increase public participation and accessibility, meetings were held at various
community clinics and sites and electronic communications were used to keep
everyone abreast of any changes. The
committee voted to establish a three-year pilot project. Here are some highlights:
•
3
years Consumer Connect
•
A
total of 80 high-speed Internet kiosks at forty provider sites
•
Interfaces
to hospitals, laboratory and jails
•
10
voice recognition software
•
5
language translators
•
3
years licensing for the San Francisco Network of Care
•
Help
desk coverage and
•
Document
imaging
Now,
Ms. Nan Dame will talk about the Consumer Connect.”
Ms.
Dame: “Consumer Connect is the software interface that provides electronic
health record (EHR) and personal health records (PHR) that are maintained in a
database system. The database is a
depository of demographics, progress notes, problems, medications, medical
history, immunizations, laboratory data and radiology reports. Clients have confidential access to their PHR
database and complete control over their personal information.”
Dr.
Jones: “It is very exciting and revolutionary for
Ms.
Dame: “The integration of primary care and mental health care records will take
some time to complete. We are still
working on it. We do plan to have a link between medications, allergies, etc.
This replaces the InSyst program”
Dr.
Jones: “Will it be more recovery based in discussion? Do you see this as treatment
plan focused?”
Ms.
Dame: “That question can be answered by Dr. Robert Cabaj.”
Dr.
Cabaj: “We are working with the State to encourage more of a strength based
approach. We hope the staff can do
both.”
Ms.
McIntyre: “Is there any security against identity theft if a laptop got
stolen?”
Ms.
Dame: “Information resides on the server only.
So public access to the database at the library would not be
compromised.”
Mr.
Purvis: “What technology do consumers have?”
Ms.
Dame: “The consumer employment would provide the training by peer consumers to
clients.”
Ms.
Arguelles: “What happens if a consumer moves to a different county?”
Ms.
Dame: “The consumer still has access anywhere just like they would with their web-access
email.”
Ms.
Arguelles: “Can an out-of-county provider have access to this record?”
Ms.
Dame: “As long as the consumer gives the provider permission to do so.”
2.2 Public comment
Mr. Scott: Mr.
Eric P. Scott mentioned that he has several serious concerns with the EHR and PHR
systems. He was concerned that data being
stored with one vendor might expose us to the risk of data loss if the provider
were to go out of business, or the vendor could raise costs and hold the system
hostage. He suggested that a two-factor
authentication should be considered. He
also thought that the Consumer Connect should be available on open-source
platforms such as Linux, Microsoft Windows and Macintosh. He was also concerned
about difficulties people with poor literacy or minimal English proficiency,
the difficulty of remembering passwords and potentially being locked out after
three attempts. He was further concerned about the tendency people have to pick
the same password for everything.
Mr. Bassiri: Mr.
Kavoos G. Basssiri wanted to know if there are policies about response time and
speeed to people’s requests and comments via electronic communications, phone
calls or letters. He suggested that it
would be good to have specific provider policy regarding response time.
Mr. Isidro: “I
would like to respond to Mr. Eric Scott’s comments. We have security features that would make it
difficult for consumer security to be compromised.”
Ms Larson: She mentioned
that she was on the MHSA-IT Planning Committee.
She was glad to have this public meeting.
ITEM 3.0 ACTION ITEMS
3.1. Public comment
No public comments.
3.2. Resolutions
3.2
a PROPOSED RESOLUTION: Be it resolved that the minutes of the
Mental Health Board meeting of January 13, 2010 be approved as submitted.
Resolution
unanimously approved.
ITEM 4.0 ELECTION OF OFFICERS
For discussion and action
4.1 Public Comment.
4.2 Report from Nominating Committee
Ms. Williams: “The Nominating Committee
stated the nominees at the January 13, 2010 meeting as: Mary Ann Jones, PhD, or
James Shaye Keys, Chair; Lara Arguelles or Susan McIntyre as Vice Chair; Mary
Ann Jones, PhD as Secretary. Additional nominations can be made from the floor
prior to voting. We will vote on each
position one by one. Sunshine laws require that we vote publicly. We will begin
with the two nominees for Chair, Dr. Mary Ann Jones and James Shaye Keys. Are there any additional nominations from the
floor? You may also nominate yourself.”
There were no nominations from the floor.
“I would like each of you to say a few
words about why you would like to be elected Chair of the Mental Health Board
and what you would bring to the board.”
Dr. Jones: “I am a
Mr. Keys: “Thank you for the
nomination. I’ve been on the board since
2005. During my time of four-and-half
years, we have done much advocacy: bringing more services to the Southeast
Sector.”
Ms. Williams: “Thank you for your
statements. Ms. Brooke will call the
roll for each candidate. You need to say yes or no to indicate your vote for
the candidate.”
Ms. Brooke: Congratulations Mr. Keys for
the Chair position.
Ms. Williams: “Now, we will vote for Vice
Chair. Lara Arguelles and Susan McIntyre have been nominated. Are there
additional nominations from the floor? I would like each of you to say a few
words about why you would like to be elected Vice Chair. Ms. Brooke will call the roll for each
candidate. You need to say yes or no to indicate your vote for the candidate.”
Ms. Brooke: “Congratulations Ms. McIntyre,
you are now the Vice Chair.”
Ms. Williams: “Now, we will vote for
Secretary. Dr. Mary Ann Jones has been nominated. Are there additional
nominations from the floor?
Mr. Wishom: “I would like to nominate
myself.”
Mr. Keys: “I would like to nominate Ms.
Arguelles.”
Ms. Williams: “Ms. Brooke will call the
roll for each candidate. You need to say yes or no to indicate your vote for
the candidate.”
Ms. Brooke: “Congratulations Dr. Jones,
you are now the Secretary.”
ITEM 5.0 REPORTS
5.1 Report from the Executive Director of
the Mental Health Board.
Ms. Brooke: ”I
would like to call your attention to the flyers in your packet about events
happening this month.. Loy met with CBHS staff and Sarah Accomazzo to put
together this years Program Review list and he can come along with any board
member who would like his assistance during the program review. He will sit in
on the provider interviews but not the client interviews. I want to call your attention to a survey
that Sarah Accomazzo did which showed that the two key issues that concern
women and girls are body image and trauma.. Finally, I want to remind everyone
about the Public Hearing at City Hall on February 25, 2010 focusing on the
impact of budget cuts.”
5.2
Report of the Chair of the Board and the Executive Committee:
No report.
5.3
Report of the Chair of the Nominating Committee: Lisa Williams
Election
completed.
5.4
Report by members of the Board on their activities on behalf of the Board.
Mr. Keys: “At
the last executive meeting we came up with the name called City in Peril to
emphasize the impact of mental health budget cuts. This is a theme at the February 25, 2010
special meeting that Ms. Brooke just talked about.”
Mr. Purvis: “This
public hearing is critical to NAMI.”
5.5
New business - Suggestions for future agenda items to be referred to the Executive
Committee.
No suggestions
made.
5.6
Public comment
ITEM 6.0 PUBLIC COMMENT
Mr. Bassiri: “I want to mention that Richmond
Area Multi-Services Inc. (RAMS) was awarded two services contracts: the Summer
Bridge program which is an eight week program for high school students to
inspire them to go into healthcare which will start in June 2010 and a Peer
Specialist Mental Health Certificate program which is a collaboration with San
Francisco State University to offer certificates which starts in September
2010, fall semester. RAMS is soliciting
inputs from stakeholders.”
Mr. Keys: “Do
these programs come from the MHSA Workforce Education and Development (WET)
money?”
Mr. Bassiri: ”Yes.”
Adjournment
Meeting adjourned
at 8:59 PM.
PRESENTATION: Information
Technology Component of MHSA
San Francisco Department of Public
Health Community Behavioral Health Services
Mental Health Services Act Proposal:
Information Technology Component
{MHSA-IT}
MHSA IT Goals
•
Increase
Client and Family Member Empowerment
–
by providing
the tools for secure client and family access to health information that is
culturally and linguistically competent within a wide variety of Public and
private settings
•
Modernize and
Transform Mental Health Services
–
by providing
transformation of clinical and administrative information systems to ensure
quality (and continuity) of care, operational efficiency and cost effectiveness
MHSA-IT Public Planning Process
•
September
2008: MHSA-IT Task Force built upon previous MHSA planning processes to
initiate a series of 10 Public meetings.
•
January 2009:
26 member MHSA-IT Planning Committee appointed by CBHS Directors.
–
Twenty-six
voting members
o
12 Consumers
o
14 Community
based providers
o
2 alternates
•
January
through May 2009: 10 Planning meetings held
–
Open to the
public
o
Notices
posted at community clinics and sites,
o
Rotated
community sites
o
Email sent to
all members and interested parties
–
Average 23
participants:
o
11
consumer/family members
o
7 community
providers
o
5 members of
the public
MHSA-IT Public Planning Process
•
The Committee
held two brainstorming sessions to identify ideas and preferences for use of
technology to improve mental health services.
•
Ideas were
prioritized and reviewed for applicability, feasibility and cost.
•
The final
vote resulted in selection of a 3 year pilot project to:
–
Add a
consumer portal to the new Behavioral Health electronic health record project
–
Enhance that
project by addition of electronic signatures, document imaging and additional
eprescribing licenses
–
Implement IT
related training and employment opportunities for MH consumers
The San Francisco MHSA-IT Proposal
CONSUMER CONNECT
Modernize and Transform Mental Health Services
{Budget = $2,004,440}
•
3 years
Consumer Connect (EHR Portal) 2 computer kiosks with high speed internet at 40
provider sites
•
eSignatures
•
Interfaces to
Hosp/Primary care, Laboratories, Jails
•
10 voice
recognition software licenses
•
5 language
translator/pocket PC/ 3 yr licenses
•
1 Full Time
Engineer
•
1 Full Time
Consumer Advocate
•
Add 3 years
licensing for the SF Network of Care
The San Francisco MHSA-IT Proposal
CONSUMER TRAINING AND EMPLOYMENT
Increase Client and Family Member Empowerment
{Budget = $1,819,910}
Consumer Support Training and
Employment:
•
Train the
Trainers - 1 Coordinator, 1 Admin. Assistant., + 8 trainees
•
3 persons to
provide Help Desk coverage 1 person for 8 hrs per day
Document Imaging
•
Point Of
Service Document Imaging: 4 persons for 3 yrs, plus supervision
•
Conversion
document imaging: 2 persons for 1 yr with training plus supervision
Consumer Connect
Electronic Health Record (EHR)
•
An electronic record of patient health information over time, generated
by one or more providers. Contains demographics, progress notes,
problems, medications, medical history, immunizations, laboratory data and
radiology reports.
•
EHR is owned and maintained by the provider
Personal Health Record (PHR)
•
A
confidential tool for managing health information and recent services, such as
allergies, medications, personal medical facts, and doctor or hospital visits
that can be stored in one place, then shared with others, as the client wishes.
•
PHR is owned
and maintained by the client
What is Consumer Connect?
•
A secured web
interface or portal into the Avatar HER
•
Provides easy
access to health information for:
•
Consumers
•
Authorized
family members
•
Authorized
providers
•
A
communication tool between consumers (and/or family members) and their care team
Features – Secure Login
•
User ID is
locked if maximum number of login attempts is exceeded
•
If the user
forgets their password, they have the ability to reset it (if they correctly
answer their pre-selected security questions)
Home Page
Appointments
Medications
Medication Comments Journal
Health Record
Treatment Plan
Treatment Plan Journal Entry
Messages
