Behavioral Health Board - Regular Meeting

Hello to everyone online. This is Laura Montagna, and we are waiting for a quorum, which we are almost at. So hang on just a second. Some people are arriving. Thank you. We found a couple.

Yeah, I didn't go through the entire book, but I got about halfway through and all I found were two pieces.

Yeah, there was one I forgot I had spotted. There could be one. There could be one.

Hey, this is Laura Montoya.

Are you coming? Hello.

Okay.

Hello. Okay, great to have you back. Josh is in the parking lot. Good.

That's coming. Okay, thank you.

Okay, thank you. But I didn't know Jacob Rosen was in the Sunday group.

Even for a trip? For a trip.

For D&D style.

Oh, yeah.

I started playing D&D at 52, 51. same time I started . And I had no idea how pervasive it is. And our social services campus eligibility, there's so much.

That's cool.

OK.

Is that the only thing we can talk about while we're sitting here?

Is that a word question? Okay. I'm still trying to get.

And then you join me.

But in the chat online, still waiting for the forum. I said it. Yes.

Or yes, voting members would have to be here in person and could not be online.

Yeah, but we can still have the presentation.

Any action items.

Vote on anything, but we can still have the presentation to fulfill that.

Sure, so she. Oh. Oh, how you doing, buddy? I don't know if there's somebody else.

We're supposed to be here and texted folks as soon as we do one more. Let's go.

You know, we talk about this every time, but can I get recordings? I actually have them.

They don't.

makes us excited everyone this is starting yeah let's go thank you there you go that way i can um yeah do the things i do do it to do the things i do okay okay all right

This is Laura Montagna, Behavioral Health Board Chair. It is 1-12, and we are going to start this special meeting. There's no intention today because I forgot it. Joe, can we do a roll call?

Sean Berger. Barb Rebstore-Degner, excuse me. Bob Gordy, in form of Raphael DiCaprio. Yes, is here hand waving.

All right. Steph, Oliver, would you like to introduce yourself?

Yeah, absolutely. Good afternoon, everybody. My name is Oliver Gonzalez. I'm the program manager here at Behavioral Health Bank.

Laura Johnson, Department of Health and Human Services. We'll go online.

Connie Beck, Health and Human Services Director for the county. Good to see you, Laura. You too, Connie. Thanks.

I am Jeremy Nelson, Deputy Director for Children's Behavioral Health.

Looks like we also have, yeah, Luke Brownfield. There he is.

Luke Brownfield, Public Defender. All right, that's everybody at home.

The adjustments to the agenda are we do not have a quorum in the room, so we will not be voting on the action items. Is there any public comment? And without further ado, we will go to our presentation. Oliver, take it away.

I'm going to put a couple things in the chat for people joining us virtually. Perfect. Well, first and foremost, I want to say thank you everybody for being here. I really do appreciate the effort that Everybody took, especially you, Laura, for getting this arranged. Without this presentation, I think we wouldn't have been able to make four supervisors, frankly. So again, this is a really big thing. I appreciate all of you guys for being here. My name is Oliver Gonzalez. I am our program manager here at Behavioral Health that oversees what we call the Behavioral Health Services Act. I'm noticing that a lot of people from the last meeting are here. So if everybody's okay with it, what I'll do is I'll kind of speed up the meeting a little bit or the presentation in case that way I'm not like boring you with the same information that you've heard a couple of weeks ago, okay? But if you have any other questions or anything comes up, by all means feel free to voice anything that may come in mind for you at the end of the presentation. So we have three main goals here, right? So one is discussing the Behavioral Health Services Act requirements and the planning process. I'm going to go over some brief data that we collected as part of our community meetings. And lastly, but not least, go over any comments, questions, or overall input people may have by the end of the meeting as well. Since we're in a conversation of input, we have a form as well, a demographic form that I put in the chat for everybody to access. joining us virtually. And then also there are physical packets that have a copy of this demographic form at the end of the document. And we have a quorum, right? So it's voluntary and anonymous. And the end of the form has a section for feedback and input as well. So I wanted to share that. And then here's a version of the electronic format. So that way people know that the end of the document does have that too. And in today's meeting, what I'll do is I'll make sure to record any and all verbal or even messages in the chat. You guys are also able to send us any comments through our HSA comments at co.humble.ca.us email address. And the only thing we ask is that for comments to be specific to our integrated plan. So with that in mind, some brief history and purpose of the Mental Health Services Act, now soon to be Behavioral Health Services Act, right? So the MHSA was enacted in law in 2004 through Proposition 63. It created something that a lot of people know as the Millionaire's Tax. It's a tax on income exceeding a million dollars. and with the intent of utilizing those dollars for behavioral health services that would otherwise not be able to rely on Medi-Cal billing. Proposition 1 came into effect in 2024 and enacted 2025. And basically what it created was a reform of the Mental Health Services Act into the Behavioral Health Services Act. This made some substantive changes to the MHSA, which I'll be addressing into this presentation. But essentially, what we can see here in the infographic here is that the 1% income for millionaires gets collected by the California State Treasurer, and then it gets allocated into two separate buckets. Bucket one is 90%, which is the big one that we see here in the lower right. And that's what gets allocated to all 58 counties in California. The 10% is a secondary bucket that gets allocated specifically for statewide initiatives, such as the Department of Health Care Services, the California Behavioral Health Planning Commission, the Department of Health Care Access and Information, the Behavioral Health Services Oversight and Accountability Commission, and the California Department of Public Health. And I do see we have a hand raised. Go for it, Jess.

Hi, I'm so sorry. I know you literally just went over the acronyms, but just for clarification's sake, what does DHCS stand for?

Yeah, that's the Department of Health Care Services.

Okay, thank you.

Yeah, no problem. Great question. So again, that's what the VHSA is in a nutshell as far as how it's structured and what its intent is. One thing I want to also emphasize in this presentation is that these percentage allocations on the VHSA are different from what we would normally see in the HSA. So in VHSA, And MHSA originally 95% of the funds would go to the counties and then 5% to the state. As you can see here, those dollars have decreased. Now 10% is going to the state. So I just wanted to emphasize that change because it does have implications for us and I'll go over in a later part of our presentation. So with MHSA or VHSA, we're intending to expand best practices and recovery-focused mental health programs. We want to reduce long-term negative impacts. resulting from untreated mental illness. And we also want to prevent mental illness from becoming severe and disabling. Additionally, we have some very important county requirements that we must follow. We need to complete an integrated plan every three years. Our most recent fiscal year plan was from 2023-2026, and that was approved in June 27, 2023. So almost four years ago, three years ago, which is just kind of crazy thinking about it like that. We also need to do two annual updates in years in between. And we also require something called the Community Program Planning Process, known as the CPPP, for integrated plans. And yes, Jess, I see your hand up again.

Yes. Is there a specific department in the county that is responsible for meeting these requirements? Or...

Yeah, so that's the behavioral health branch. So it's behavioral health branch specific. And if you want to talk about like a team, you are talking to them. It's just me, myself, and I doing all this.

All right. Heck yeah. Good to know.

Dream team. So, so yeah, great question. And then of course my, my, my partner in crime, my right hand, Alex Oliveira, who couldn't be here with us today, but yes, it's just us two basically. So, The BHSA is structured into three separate categories, right? So we have our 30% allocation to housing interventions, 35% to full-service partnership, and then a 35% to the behavioral health services and supports. Now, this diagram is describing a couple of things at once. So first and foremost, it's mentioning the 90% state allocation, right? So that's That's what gets divided out between all counties after the state takes its 10% cut. And then the percentages you see on the left are the percentages that go to each individual bucket of the BHSA that counties need to be using. So just wanted to kind of call that out because that's why it doesn't add up to 100% on the top because it's communicating two separate things. So for Humboldt County, specifically fiscal year 2026-2027, we're looking at a budget estimate of a little over $11 million, $11.2 million to be specific. And what we see here in this pie chart is, again, those percentages that we just kind of went over, but with their associated dollar figures. So again, just to show that what is going to each bucket and how come it's going that way. Those percentages that I just kind of went over are specifically written in statute per state. So we need to be following those percentage distributions. So in case you may be wondering why it's structured that way. Now I'm going to be going in a more granular level each individual bucket of the VHSA. First, we'll start with the housing intervention bucket, which is that 30% we just saw. It is intended to reduce homelessness among HSA eligible individuals, emphasize permanent supportive housing and housing first principles. There's some expectations and requirements around county coordination with managed care plans. Ours is being partnership, right? And it can fund rental subsidies, operating subsidies, support development of new housing units, and even outreach. As far as eligible populations go, It includes chronically homeless, experiencing homelessness, or at risk of homelessness, individuals exiting institutions or carceral settings who were homeless before entry, and those transitioning from the Medi-Cal transitional rent benefit, which is a brand new benefit intended to provide six months of additional funding to people who are trying to enter our system of care before using the HSA dollars.

Yes, sorry, take over. Could you explain that, the last probably five paragraphs that we just said? Yeah. So most of our people are already getting six months ECM, so it's being extended?

So there's another funding source that we have access through the partnership. And it's supposed to, in theory, what it's supposed to do is it's supposed to fund the first six months of people's interim setting. So that's like a hotel stay as an example. Okay. That is supposed to be done in partnership with partnership for us. Would that be like new life? Partnership helper. When you say motel? It would be like Flamingo as an example.

Okay.

And essentially what we need to be doing is we need to be coordinating with partnership. I know here in Humboldt County, our home program is the one in charge that has been doing the coordination behind the scenes. And essentially, we are contracting or have contracted with partnership to become the transitional rent provider. So that's a new mechanism that we're utilizing. It's still in development, I would say, in terms of the workflow and seeing how referrals are going to work and all that. But that is a system that is being spent up right now.

The reason why I ask is that because I have a few people that are ending their six months like partnerships, sober living, for example. And so I was hoping that maybe they were getting an extension.

There is a bit of a distinction there, and I would maybe reach out to our housing providers on that one, because I'm not a subject matter expert of that element, at least.

I'll let you know after. Oh, thank you. I do have questions, though, because it does open up some ideas for long-term care. Absolutely. I'm willing to chat with you guys after we're done.

Priority groups for this housing interventions is children, youth, and juvenile systems, child welfare, and even at risk of institutionalization. And we also have adults and older adults who are at risk of the justice system, conservatorship, or institutionalization. One big point, too, that the state wants us to emphasize with this housing intervention is dollars, is that these dollars shall not be limited to just full-service partnership clients. That's an important distinction because historically, the MHSA has used these dollars for full service partition. So this bucket in practice, it may have been new, but in actual practice, it's relatively the same practice. It's just opening these dollars to a more broader population in essence, but it doesn't increase the dollar quantity available to canons, right? So I just wanted to really emphasize that point So for behavioral health services and supports, which is our second bucket, we have a 35% allocation. Purpose of this is to serve children, youth, adults, and older adults. It focuses on early access, stabilization, and prevention of worsening conditions. And it prevents escalation to crisis, homelessness, or justice involvement. This section actually has a lot living in it. So for instance, it has outpatient mental health and substance use disorder services. It has outreach and engagement, workforce education and training. It's got early intervention programs, which I'll get onto in a little bit. And it also has innovation programs. So again, a lot lives in this section. So I wanted to just kind of call that out. Here in early intervention, right, at least 51% of BHSS funds must be allocated to early intervention. Of these early intervention funds, a minimum of 51% must be allocated to people aged 25 years of age and younger. So it's taking that 51% slice and it's making it more granular to another 51%. One important point that I want to emphasize about this section, which is new to the BHSA, is that moving forward, counties can only engage in a form of prevention known as indicated prevention. This is a form of prevention that is specific to targeted individuals who are at risk. It should not be universal prevention, which is the type of prevention historically the MHSA would support. Universal prevention would essentially look at population-wide prevention. You may be wondering, what does that mean for us here in Humboldt County? Essentially, that means that we can't support certain initiatives that we have done so in the past. such as our suicide prevention program with public health. That is one of the biggest effects to this transition, that we need to now be specific to indicated at-risk prevention. So programs within the BHSS category, as I mentioned, there's many of them. And here in this slide, I have a list of all of the ones that will be living in this section. Yes, do you have a question for Nat?

Well, I'm trying to, like, figure that statement out. So, because it seems like, it sounds like a play on words to me. There's not a budget for the suicide prevention, but we're working towards helping at risk. Wouldn't suicide prevention be at risk?

So, I think, yeah.

I'm just trying to, like, I wrap my head around that.

Yeah, I believe you're echoing an argument that I've heard many other counties mentioned to the state, and that is, well, certain counties, Humboldt included, have really high prevalence rates in soliciting. Wouldn't that necessarily, wouldn't that make us an at-risk county, right? However, although that may be true, DHCS has mentioned, well, that's due population-wide. And part of the dollars that I mentioned in the beginning, right, that 10% of the state's staking, They're taking more out of VHSA so that they could do their own population-wide initiatives as well. Whatever those initiatives may entail, we still don't know. However, that is at least the intent that has been voiced to counties that have questioned the initiative.

Sorry for asking.

It's okay. It's a super valid question, and I know, Jess, I see your hand up, so go for it.

Yeah, it's really interesting. Instead of focusing on common trends, it's focused on the individual. And I guess my main question, I know nobody's going to have an answer to this, but it's something to kind of keep an eye on, is how are they going to decide who is eligible for those individual-focused services? Yeah. I don't know. It seems very as though some people might be receiving benefits and some might not. But that's neither this presentation.

So I mean, to answer your question, and maybe somebody else can answer that question a little bit better than I can. But essentially, what we're trying to leverage and what they're trying to bank on here is that counties already have a screening process, right, to identify cases. And ultimately, it's through that screening process that we would be identifying people to serve to be served essentially, right? So in that sense, that's the system we will be leveraging for this. So again, those are all the services that live in the VHSA specifically, okay? I'll move on to the next slide here. And we're getting to our final third bucket here of the VHSA, and that is our full service partnership, FSB. Here in Humboldt County, our FSB program is known as that Comprehensive Community Treatment Program, CCT for short. They are the highest intensity BHSA services for people with severe behavioral health needs. They're oftentimes described as the whatever it takes service delivery, because whatever needs to happen to get the individual stabilized and placed in a safe location is what program is meant to do through these BHSA dollars. So it focuses on individuals at risk of homelessness, hospitalization, or even justice involvement. And here I have like a little note about how it differs under the BHSA. And this is a point that kind of came up already early on in this presentation, right? And that is that all housing normally done through the FSB bucket now needs to be done through the housing intervention section. So again, it's the Yes, it looks like it's new money because it's a new bucket, but in reality, in practice, Humboldt County has been leveraging these dollars to sustain its FSB placement costs and housing costs. So for us, in practice, this change doesn't really do a whole lot for us as far as making those dollars available to the public, if that makes sense, right? FSB programs can also serve folks who have standalone SED diagnoses. and incorporate the need to have low-barrier access to medication-assisted treatment services. So this is a new addition for us, and we're currently developing policies and procedures to be able to leverage existing pipelines to do that. And then also there's a requirement to implement evidence-based practices, which I have listed here. A little fun fact, I suppose, is that our CCT program is based out of assertive community treatment. These acts have known for sure. So we, we used the act model to create our CCT program. Uh, as a small County, we can actually leverage small County exemptions, which is exactly what we're doing here for, for these specific EPP, because we don't have the staffing capacity to send off all of them. So you're going to kind of mention that as far as challenges go, I feel like I kind of hit on some of these, right? So as you've kind of noticed, PHSA is a big major system redesign, right? And it's not a funding increase. So the kind of like to mention it previously in MHSA, we would get 95% of the dollars. Now we're seeing 90% of the dollars going to the families, right? So that's something I wanted to emphasize. The other thing is the new requirements exceed current local capacity. I just briefly mentioned that some of the evidence-based practices that are required we can't stand up fully because we just don't have the staffing capacity to do so. There's certain estimates that the state gave us where they're saying, oh, you need 30 clinicians to do this one specific thing. And it's like, well, we don't even have 30 clinicians for that, right? So there's that. Housing availability, staffing levels, and required services models all depend on one another, right? So everything's super interconnected. For lack of a better word, everything's become integrated, right? Counties must balance compliance with maintaining essential local services. And that's kind of a call out to not being able to fund our suicide prevention program as a result of not being able to do universal prevention moving forward. And then also tight timelines and evolving state guidance, increased implementation challenges. I am currently summarizing to you 400 plus pages worth of legislative language, right? Which is a lot. And there is more to come in the near future. not all of the guidance that we have right now is up to date still. So again, just kind of a call out to that. So this is the part of the presentation where we'll kind of go over some of the outcomes, some of the things that were mentioned in our meeting spaces throughout this year. And I'll keep this section a little bit more in the briefer side since I feel like everybody that was in the meeting last time is here this time. So again, thank you for being here. So we had a total of 17 meetings with a total of 159 participants attending our in-person or either in-person or virtually. Out of these 159 people, 48, which is roughly 30%, completed a demographic survey. And we also had a community survey blasted out to our community with a total of 148 participants or responses. So as far as community meeting data goes, right, here I am showing you some attendee residents. So with 38% being the majority of being predominantly Eureka. So I'll make these sections quick. Here we have our historically underserved populations. So what we show here in blue is our general population based on census data for Humboldt. And in orange, we see the numbers of people that fill out a demographic survey and identify as being a member of these populations. So as you can see for African-American or Black and Asian Pacific Islander, we didn't have people identify as that. However, I do want to say that this is based on people that filled out the form. So we did have representatives of these groups. They just didn't fill out a survey. So done. And then as far as gender, we have here 67% being identified as female with 27% identifying as male. Here we have attendee age, 11% as 65, and 60% as 26 through 59, and 27% at 60 plus. Here we have community members with lived experience, right, with 29% with diagnosed with an SMI, 65% with a family that has a diagnosis, and 71% with a friend that may have a diagnosis. And then here we have percentage of Canadian members who identified as a number of a special population, which I will just let you see that real quick. And then every meeting had a lot of comments that we ended up analyzing and creating themes around, right? The top three themes that came up were comments regarding PHSA implementation, which included either confusion, frustration, or overall just additional need for guidance. as to why the changes are happening and how they are going to affect us at the local level. Increased support for the youth. So we have several conditions and proposals specifically for BHSA-funded child support services. So those are being considered. And then the third one being expanding or increased access to services. So more specifically, regional. So having more services around Southern and Eastern Humboldt, just to name a couple of examples. Now, as far as our community survey, we had, again, 148 responses. Here we had 15% of people identified that it was not their first time answering a survey, and 84% identified that it was their first time answering the survey. So that's one of the things that we can note is that participation has kind of been declining. but we're noticing that the people who are more likely to respond are people who are doing it for the first time. So kind of an interesting metric that we noticed. As far as respondent region, a majority of the individuals that responded came from Eureka. And then as far as respondent age range, we had people 1% in the 0 to 15 category, 16 to 25 were 9%. and 72% were at 26 to 59, and 14% were super marginalized. As for gender identity, we had about 1% identify as another gender identity, 78% as female, and 1% as genderqueer, 13% as male, and then 6% preferred not to answer. And then we also had gender at 1% too. As for rate and ethnicity, As we can see here, the majority of the responders survey identified as white, 47%. And then we had a various plethora of other categories or ethnicities as well being reported here. With the survey, we also asked people for additional comments or input. And we also categorized them into themes. The top three themes that kind of came up for it is increased behavioral health services with 32 mentions. Improving access to services with 27, and increased staffing and recruitment with 19 responses mentioning this theme. And then as far as the top themes go, here I'm kind of just mentioning a couple of examples, right? So for instance, those comments regarding HSA implementation, right? Many of them including questions, frustrations, and those concerns that I kind of mentioned earlier, right? Then we had that theme about increasing support for youth, right? More specifically around school-aged children or the zero to five population and including even neurodivergency. We had also expansion or increased access to services, which again, it's kind of mentioning expansion to services that are outside of the Eureka region. Workforce support, so again, that recruitment and retention strategies, right, wanting to expand available practitioners available at the local level. And housing and services for those experiencing homelessness. This was mentioned a couple of times, and given that the housing intervention bucket is new, I wanted to call this out specifically just because, again, a lot of members express concern with instability and homelessness being presented as a major thing. So as far as next steps go, really ultimately input in today's meeting will be collected and it will be developed or taken into account for future planning. Our report will go to our behavioral health leadership team. So like Emmy has an example for consideration. And then last but not least, we'll be going to BOS next Tuesday to get our plan passed so that it can go into full effect by July 1st. Here is kind of an infographic kind of showing the, the timeline we use to get this integrated plan, uh, drafted into the stage that we're at today with us being literally in the June end of things. So we are right at the finish line. So that concludes my presentation and I will open the floor for any additional comments or inputs. Thank you. And again, thank you so much for reviewing this presentation. You're an absolute rock star.

Great job.

Thank you, Oliver.

Once again, Oliver, you are very thorough and I just admire you being able to speak so eloquently like you do.

Appreciate that. Thank you. It's been a big learning moment.

I want to learn that when I grow up. I'm not very eloquent.

Yes, you are. Are there any comments or suggestions or anything online?

I don't see anything in the chat either.

Just for Tuesday, are you going to be doing this full presentation for our board?

You guys are receiving a more condensed version.

Okay. Yeah.

You guys will be receiving a more condensed conversation. And I don't know typically when you guys get the slides, but those were already uploaded for you guys.

It should be an attachment to the agenda when it comes out. It'll probably come out today because tomorrow's a holiday. Right. And then we're going to be missing one board member. So I want to just make sure, possibly two, you just need a majority vote, right?

Yes. Are you saying a majority vote? Okay. Okay. Great.

I got three people there. My God.

We'll get it. It's been a little hard. Do you know if Mike's going to be there?

Mike is not going to be there. He'll be out of town. And Michelle had an emergency come up. So TBD. But it'll definitely be me chairing. Stephen Rex will be there for sure.

Does that mean, are you authorized to sign documents, too, in the absence of the chair, if that's the case?

Yeah, I'm the vice chair.

Awesome. There's a certification that the BOS needs to sign at the end, please.

Yep, we'll make sure that's done.

Thank you.

All right.

Perfect.

Well, that is the end of that presentation. Thank you so much. Since the meeting started, we now have an in-room quorum. I would like to bring back the action items. And my first one is approval of the minutes from the 4-23-26 meeting. So moved. Second. Thank you. All in favor. All in favor.

Aye. Aye.

Aye. All right. Great. And then second thing, approval to send membership applications to the Board of SOUPS for Alan Miller, Betty Morgan, and Saul Lopez. Do I hear a motion? So moved. All in favor of sending those applications, please say aye. Any opposed? All right. Jess, thanks for being there. Awesome. All right. If there's anything else anyone has for the very good? Do we need to vote on this presentation or just you just proceed it?

We have received it. We have received it.

Twice. All right. So with that, this meeting is adjourned. Really? You're wrong.

1047. Thank you. Thank you all. Natalie, thank you so much. It was funny. I was triple booked for things that I needed to do. I don't know how I'm going to do that. Well, I need to see your face. No, no, no, no, no. On one of our meetings, our budget adoption is scheduled for July 7th. But I guess we just take different. Week without budget, and the new year without budget.