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Consolidated Report on MHSA

Community Engagement Activities

Contra Costa County Behavioral Health Services

Contra Costa Behavioral Health Services Consolidated Report on MHSA Community Engagement Activities

Funded by the Mental Health Services Act in partnership with Contra Costa Mental Health Prepared by Resource Development Associates I April 18, 2014

Table of Contents

Introduction .................................................................................................................................................. 7

Background on the MHSA ......................................................................................................................... 8

Community Engagement ............................................................................................................................ 10

Description of Community Engagement Activities ................................................................................. 10

Planning Approach and Process .......................................................................................................... 10

Community Engagement Activities ..................................................................................................... 11

Stakeholder Participation ....................................................................................................................... 13

Focus Groups ....................................................................................................................................... 13

Community Meetings .......................................................................................................................... 17

Community Engagement Results Overview ................................................................................................ 21

County-Wide Results ............................................................................................................................... 21

Community Engagement Results by Population ......................................................................................... 27

Children System of Care .......................................................................................................................... 27

Transitional Age Youth (TAY) System of Care ......................................................................................... 30

Adult System of Care ............................................................................................................................... 32

Older Adult System of Care ..................................................................................................................... 35

People Experiencing Homelessness ........................................................................................................ 39

Latino Community ................................................................................................................................... 42

Asian & Pacific Islander (API) and Native American Communities ......................................................... 44

Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) Community .................................................. 47

Family Members and Loved Ones of Consumers ................................................................................... 49

Appendices .................................................................................................................................................. 53

Appendix A: Focus Group Facilitator’s Protocol ..................................................................................... 54

Appendix B: Informational Flyer for Focus Group Events ....................................................................... 61



Appendix C: Logistical Flyer for Focus Group Events .............................................................................. 62

Appendix D: Contra Costa Mental Health Assessment of Needs Handout ............................................ 63

Appendix E: Contra Costa Mental Health Service Providers Handout .................................................... 66

Appendix F: MHSA Values and Components Handout ........................................................................... 71

Appendix G: Focus Group Participation Summary Handout................................................................... 73

Appendix H: Participant Demographic Form .......................................................................................... 75

Appendix I: Community Forum Presentation ......................................................................................... 76



List of Tables and Figures

Figure 1: MHSA Values .................................................................................................................................. 8

Figure 2: Community Program Planning Process .......................................................................................... 8

Figure 3: Community Engagement Activities .............................................................................................. 10

Table 1: Community Planning Activities and Dates .................................................................................... 11

Table 2: Total Count of Participants by Community Planning Activity ....................................................... 13

Figure 4: Community Engagement Participants by Communities and Geographies .................................. 14

Table 3: Total Count of Participating Consumers and Family Members by Population ............................. 14

Table 4: Total Count of Participating Service Providers by System of Care ................................................ 15

Table 5: Total Count and Percentage of Participants by Stakeholder Affiliation ....................................... 15

Figure 5: Percent of Focus Group Participants by Age (n=220) .................................................................. 16

Figure 6: Percent of Focus Group Participants by Gender (n=222) ............................................................ 16

Figure 7: Count of Focus Group Participants by Race/Ethnicity (n=220) .................................................... 17

Table 6: Count of Focus Group Participants by County Region (n=223) .................................................... 17

Table 7: Count of Community Forum Participants by County Region (n=111) ........................................... 18

Figure 8: Percent of Community Meeting Participants by Stakeholder Affiliation .................................... 18

Figure 9: Percent of Community Meeting Participants by Age (n= 32) ...................................................... 19

Figure 10: Percent of Community Meeting Participants by Gender (n= 32) .............................................. 19

Figure 11: Percent of Community Meeting Participants by Race/Ethnicity (n=32) .................................... 20

Figure 12: Percent of Community Meeting Participants by Place of Residence......................................... 20



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Introduction

Contra Costa County began the Community Program Planning (CPP) process for its Mental Health

Services Act (MHSA) Three-Year Program and Expenditure Plan 2014 – 2017 in September 2013. Contra

Costa Behavioral Health Services (CCBHS) contracted with Resource Development Associates (RDA), a

consulting firm with mental health planning expertise, to facilitate the community engagement phase

and inform CCBHS’s development of the Three-Year MHSA plan. The community engagement portion

was conducted from January – April 2014 and encompassed a portion of the CPP process in which RDA

facilitated 23 stakeholder focus groups and four community forums with consumers, family members of

consumers, providers of MHSA services, and County mental health staff. RDA conducted community

engagement activities in collaboration with Peers Envisioning & Engaging in Recovery Services (PEERS), a

consumer-led organization that promotes social inclusion through outreach, consumer empowerment

training, and media that challenges stigma and discrimination against people with mental health issues.

The purpose of this report is to describe Contra Costa County’s community engagement efforts and

summarize the community’s prioritized mental health needs and strategies to improve the mental

health system. This report is comprised of the following sections:

Overview of the community engagement activities that took place in Contra Costa County from

January 2014 through April 2014. Community engagement included the participation of mental

health consumers, family members, mental health providers, County staff, and stakeholders

from community based organizations across various sectors, including law enforcement and

education. The community engagement activities sought broad participation by stakeholders in

order to reflect the needs and ideas of its diverse communities. These groups include consumers

at every age group (Children/Parents, Transitional Age Youth (TAY), Adults, and Older Adults);

people experiencing homelessness; and the Latino, African American, Asian Pacific Islander

(API), and LGBT communities.

Review of prioritized mental health needs that outlines both the strengths and opportunities to

improve the mental health service system in Contra Costa County. Based on stakeholders’

feedback obtained during the community engagement events, this portion of the report

identifies the priority mental health needs by target demographic.

Review of prioritized ideas and/or strategies to address the priority mental health needs and

enhance the current mental health system. Strategies and ideas were developed by participants

across all of the community engagement events.



Background on the MHSA

Proposition 63 (Mental Health Services

Act) was approved by California voters in

2004 to expand and transform the public

mental health system. The MHSA is

funded by imposing a one percent tax on

individual annual incomes exceeding one

million dollars. The MHSA represents a

statewide movement to provide a better

coordinated and more comprehensive

system of care for those with serious

mental illness, and to define an approach

to the planning, delivery, and evaluation

of mental health services that are in

alignment with the MHSA Values (see

Figure 1).

The CPP process is an integral component

of MHSA, which requires a meaningful stakeholder process to provide subject matter expertise to the

development of plans focused on utilizing the MHSA funds at the local level. In 2013, Contra Costa

initiated this activity by completing an initial needs assessment for the Three-Year Program and

Expenditure Plan 2014-2017. RDA and PEERS were contracted to carry out the next phase—community

engagement—of the CPP process (see Figure 2: Overview of the CPP Process).

Figure 1: MHSA Values

Figure 2: Community Program Planning Process



Community engagement activities sought to obtain stakeholder input on addressing service delivery

gaps that have emerged as well as enhancing those mental health services offered by current MHSA

programs.

This report reflects the deep commitment of Contra Costa County BHS leadership, staff, providers,

consumers, family members, and other stakeholders to the meaningful participation of the community

as a whole in designing MHSA programs that are wellness and recovery focused, client and family

driven, culturally competent, integrated, and collaborative. We are hopeful that this synthesized report

of community voices will inform the development of the Three Year MHSA Program and Expenditure

Plan.



Community Engagement

Description of Community Engagement Activities

Planning Approach and Process

In December 2013, Contra Costa Behavioral Health Services (CCBHS) initiated a planning process for the

Mental Health Service Act (MHSA) Three-Year Program and Expenditure Plan for fiscal years 2014-2017.

The planning team was led by Warren Hayes, CCBHS MHSA Program Manager; Gerold Loenicker, CCBHS

Mental Health Program Supervisor; Erin McCarty, CCBHS Acting MHSA Project Manager; and Resource

Development Associates (RDA), a consulting firm with mental health planning expertise.

The planning team used a participatory framework to encourage buy-in and involvement from

stakeholders including consumers and family members, mental health service providers, and other

interested community members. Community engagement was divided into four phases: 1) Project

Launch, 2) Conducting and Documenting Events, 3) Report Back to Community, and 4) Consolidated

Report. Figure 3 lists the activities included in each phase.

Throughout the community engagement phase of the CPP process, the team held regular phone

meetings. At these meetings, updates were provided on community engagement activities, community

outreach and ways to improve outreach based on stakeholders’ feedback. For instance, after meeting

with the planning team and based on feedback from the Consolidated Planning and Advisory Workgroup

Figure 3: Community Engagement Activities



(CPAW), it was decided to include a County-wide LGBT consumer focus group, add a Latino community

focus group in Central County, and expand the Latino focus group in East County to include the African

American community and focus on children and family issues. An additional general stakeholder focus

group was organized to ensure the participation of community members, specifically parents of adult

consumers, who were unable to attend previous focus groups events.

Community Engagement Activities

RDA carried out a set of community focus groups and community forums to ensure that the prioritized

mental health needs and ideas/strategies for improvement reflected stakeholders’ experiences and

suggestions. Community engagement activities and their corresponding dates are presented in the table

below, followed by a detailed description of each activity.

Table 1: Community Planning Activities and Dates

Activity Date

Planning Process Refinement

Kickoff Meeting with CCBHS and CPAW December 5, 2013

Community Engagement

Consumer and Family Member Focus Groups January 28 – February 25, 2014

Provider Focus Groups February 25 - 27, 2014

Reporting of Program Strengths and Needs

Community Forums March 19 - 26, 2014

Presentation to CPAW & MHC April 3, 2014

To initiate the planning process, the RDA held a project launch meeting with CCBHS and the

Consolidated Planning and Advisory Workgroup (CPAW). At this meeting, RDA presented an overview of

the community engagement activities in relation to Contra Costa’s CPP process, timeline of events, and

the types of stakeholders the County would engage in community focus groups. Based on input from

CPAW, RDA expedited its timeline for conducting community engagement activities to end in April 2014

and ensure our efforts coincided with the development of the County’s Three-Year Program and

Expenditure Plan.

RDA and PEERS staff conducted 23 focus groups to gather input from mental health providers and

community members about their experiences with the County’s mental health system as well as their

recommendations for improvement. Participants were asked to reflect on what works well in the

current system, what is missing or where there are gaps, and what strategies or programs could address

identified gaps or improve MHSA services. The complete facilitator’s protocol has been included in

Appendix A.



The focus group format allowed the planning team to reach a greater number of participants, and gave

participants the chance to discuss topics among themselves, thereby producing additional information

that might not have emerged in individual interviews. Outreach and recruitment efforts for the focus

groups were conducted by CCBHS staff involved in the MHSA planning team and service providers with

connections to the various priority populations. Focus groups were advertised through the distribution

of two flyers. The first flyer explained the purpose and format of the meetings (see Appendix B). The

second flyer provided logistical information, such as the date, time, and location of each event (see

Appendix C). Focus groups were held at various community-based and mental health agencies

throughout the County. Each meeting lasted approximately 90 minutes and snacks/light refreshments

were provided.

Eighteen of the focus groups were targeted for consumers, family members, and representatives from

unserved, underserved, and inappropriately served groups. This included focus groups specifically for

each age group identified in the MHSA (Children, TAY, Adults, and Older Adults) as well as people

experiencing homelessness and the Latino, African American, Asian Pacific Islander (API), and LGBT

communities. Consumer and family member focus groups were held throughout the county in the west,

east, and central regions, which represent the highest concentration of people who access and are

eligible for the public mental health system. Consumers and family members were offered $15 gift

cards in appreciation for their participation in the community focus groups.

An additional five focus groups were held with MHSA providers. There was one focus group for each

age range (Children, TAY, Adults, and Older Adults), and an additional focus group for Older Adults.

Provider focus groups were convened in the central part of the County, however providers from all

County regions were in attendance.

After completion of the consumer and provider focus groups, RDA and PEERS synthesized the results in

order to integrate program strengths, key mental health needs for each population, barriers to entry

and access to mental health services, and recommendations for addressing the challenges and barriers.

The results and analysis of 23 focus groups with consumers, family members, and service providers were

presented to stakeholders in a second series of community engagement activities. RDA and PEERS co-

facilitated four community forums, one for each region of the County and one joint presentation to

CPAW and the Mental Health Commission (MHC) at a regularly scheduled CPAW meeting. The

community meetings were two hours long and each had an average of 40 participants.

The purpose of the community meetings was to review the findings from across the community, validate

findings, and solicit further feedback on the proposed needs and strategies that were developed from

the focus groups. Flyers for the community meetings were distributed by email to MHSA stakeholders,

including MHSA providers, community-based providers, and all individuals who signed up for email

updates during the focus groups activities as well as through the MHSA coordinator’s email list serve.

Additionally, advertisements were placed in the local Contra Costa newspaper.



During the community forums, stakeholders had an opportunity to comment on the results of the focus

groups. Stakeholders also provided feedback on how well the community engagement activities

reflected their input. Participants were given four handouts to guide the discussion: 1) Overview of the

CCBHS Assessment of Mental Health Needs, 2) Overview of Current MHSA Providers, and 3) Overview of

the MHSA Values and Components (see Appendices D – F). Demographic Data of the Community

Engagement Participants (see Appendix G) included information regarding the total number of

participating consumers and family members by population, participating service providers by systems

of care, the stakeholder affiliation of participants, as well as proportion of participants by gender, age,

race/ethnicity, and place of residence.

Stakeholder Participation

Special efforts were made to ensure that consumers were represented in all phases of community

engagement. RDA and PEERS conducted 23 focus groups, of which 18 of the meetings were held with

consumers and family members; five focus groups were with service providers.

The community planning process concluded with three community meetings and a presentation at the

April CPAW and Mental Health Commission (MHC) meeting. A total of 427 stakeholders participated in

all community planning activities. The following table presents the number of participants at each

activity.

Table 2: Total Count of Participants by Community Planning Activity

Community Planning Activity Total Count of Participants

Consumer and Family Member Focus Groups 232

Service Providers Focus Groups 55

Community Meetings & CPAW/MHC Meeting 140

Total 427

Focus Groups

Emphasis was placed on guaranteeing consumers and family members were represented in all

community engagement activities with consideration for the demographic and geographic diversity of

Contra Costa County. CCBHS sought input from consumers and family members throughout the life span

as well as specific target groups. These target groups included people experiencing homelessness and

the LGBTQ community in addition to several communities of color—African American, Asian and Pacific

Islander, and Latino communities. See Figure 4 below that summarizes the different communities and

geographies of community engagement participants.



In an effort to reach Contra Costa County’s large Latino community, a Spanish-language interpreter was

provided at the Latino consumer focus groups in West and East Counties, and the Central County focus

group was conducted in Spanish by a bilingual facilitator. Additionally, handouts, demographic forms,

and comment cards were translated into Spanish. Because only three community members participated

at the API consumer focus group, an interpreter was not requested. One focus group also targeted

African American families, in addition to Latino families; however, no African American stakeholders

attended this group. The TAY, Adult, and Older Adult focus groups included African American

consumers.

Table 3: Total Count of Participating Consumers and Family Members by Population summarizes the

focus groups conducted with consumers and family members by population. Table 4: Total Count of

Participating Service Providers by System of Care presents the number of participants at each provider

focus group, organized by system of care.

Table 3: Total Count of Participating Consumers and Family Members by Population

Focus Group Type Count of

Participants % of Total

Transitional Age Youth (TAY) 66 28%

Adult 22 9%

LGBTQ 28 12%

Older Adult 24 10%

People Experiencing Homeless 19 8%

General Consumers and Family Members 14 6%

Latino Community 54 23%

Children & Parents 2 1%

Asian & Pacific Islander Community (API) 3 1%

Total 232 100%

Figure 4: Community Engagement Participants by Communities and Geographies



Table 4: Total Count of Participating Service Providers by System of Care



TAY Provider 23 42%

Children Provider 10 18%

Adult Provider 7 13%

Older Adult Provider 15 27%

Total 55 100%

Of those who participated in the focus groups, 167 participants indicated their organizational affiliation.

Table 5: Total Count and Percentage of Participants by Stakeholder Affiliation illustrates the number and

percentage of each type of stakeholder group represented in the community focus group events. The

majority of participants’ affiliation was with a community-based organization (39%) or county

government agency (15%). In addition to an affiliation with a community-based organization, many

participants specified the sector in which they worked. As a result, these participants checked law

enforcement, education, alcohol and drug services, medical or healthcare, or Veterans organization.

Table 5: Total Count and Percentage of Participants by Stakeholder Affiliation

Stakeholder Affiliation Count of Participants % of Total

Community-based organization 65 39%

County government agency 25 15%

Education agency 17 10%

Provider of mental health services 14 8%

Medical or health care organization 6 4%

Social service agency 6 4%

Law Enforcement agency 1 1%

Provider of alcohol and drug services 1 1%

Other 32 19%

Total 167 100%

Participants who did not affiliate with an institution, identified with a particular population (e.g.

consumer, caregiver for foster youth, disability) or occupation (e.g. in-home care, public benefits

advocate, life coaching).

Each focus group requested participants to complete an anonymous demographic form (see Appendix

H). These forms asked participants to report their age, gender, race/ethnicity, and whether they

identified as a consumer, family member, or service provider (participants could choose more than one

status). Responses from the demographic forms are described below. Because demographic forms were

optional for participants, some participants may not have submitted forms or may have declined to

respond to certain questions.



16-24 22%

25-59 52%

60 and older 22%

Under 16 4%

Participant Age Range

Participants were given the choice of selecting from four different age ranges corresponding to the

MHSA categories of Children, TAY, Adults, and Older Adults. A little more than half of participants were

25-59 years of age. The proportion of Transitional-Age Youth and Older Adults was the same (22%). Four

percent of participants were under 16 years of age (see

Figure 5: Percent of Focus Group Participants by Age (n=220)

Participant Gender

Sixty percent of focus group participants identified as female, a little over a third (37%) identified as

male, and 3% identified as transgender (see Figure 6).

Participant Race/Ethnicity

Figure 7: Count of Focus Group Participants by Race/Ethnicity (n=220) indicates that the majority of

focus group participants were Caucasian. Approximately sixty participants identified as Hispanic/Latinos,

resulting in the second highest racial/ethnic group to be represented in the stakeholder focus groups.

The majority of bi-racial participants identified as Caucasian and African American, Caucasian and Latino,

and Caucasian and Native American. The two participants who checked other, identified as Middle

Eastern.

Female 60%

Male 37%

Transgender/ Gender-

fluid 3%

Figure 6: Percent of Focus Group Participants by Gender

(n=222)



Figure 7: Count of Focus Group Participants by Race/Ethnicity (n=220)

Participant Place of Residence

Because Contra Costa is a vast county, with each region characterized by diverse needs and challenges,

focus groups with target populations were conducted in each region. Table 6: Count of Focus Group

Participants by County Region (n=223) illustrates the total number of participants and percentage based

on county region. The majority of focus group participants were from Central County (40%).

Approximately a quarter of participants resided in West and East County, respectively. Within Central

County, the majority of participants reported they reside in Concord and Richmond. Other popular cities

of residence include: Antioch, Martinez, Pittsburg, and Walnut Creek.

Table 6: Count of Focus Group Participants by County Region (n=223)

County Region Count of


West 54 24%

Central 90 40%

East 57 26%

Other 22 10%

Total 223 100%

Community Meetings

The second phase of the community engagement process involved presenting the findings from the 23

focus groups and soliciting further feedback on identified mental health needs and recommendations.

Three community meetings were held, one in each region. A fourth meeting was organized to present to

CPAW and the Mental Health Commission (MHC). At each forum, RDA presented both the consolidated

and population specific results of the focus group events (see Appendix I for the Community Forum

Presentation). Table 7 lists the total count of participants at each community meeting and the

CPAW/MHC meeting. Similar to the focus groups, the Central County community forum drew the largest

number of participants (29%).

80

59

39

22

14

4

2

0 10 20 30 40 50 60 70 80 90 100

White/Caucasian

Hispanic/Latino

African American/Black

Asian or Pacific Islander

Multi-Race

American Indian/Native Alaskan

Other

Number of Participants



Table 7: Count of Community Forum Participants by County Region (n=111)



Central 41 29%

East 38 27%

West 29 21%

CPAW 32 23%

Total 140 100%

Community meeting participants were asked to identify their stakeholder affiliation. Of the 32

participants who responded to the demographics survey, the majority of participants (44%) were

providers of mental health services (see Figure 8: Percent of Community Meeting Participants by

Stakeholder Affiliation). In addition to citing they were a mental health provider, some participants also

checked they were providers at a community-based organization, education agency, or law

enforcement. Those participants who marked Other specified they identified as a consumer or peer

specialist. Several participants identified with the advocacy group, National Alliance on Mental Illness

(NAMI).

Figure 8: Percent of Community Meeting Participants by Stakeholder Affiliation

Similar to the focus groups, facilitators requested the participants to fill out an anonymous demographic

form (see Appendix H). Participants were asked questions regarding age, gender, race/ethnicity. In

addition, they were asked their city of residence in the County and if they identified as a consumer,

family member, or service provider (participants could choose more than one status).

44%

15%

15%

7%

4%

4%

4%

7%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Provider of mental health services

Community-based organization

Education agency

County government agency

Law enforcement

Medical or healthcare organization

Provider of alcohol and other drug services

Other



This section reviews the results from the demographic surveys. Because demographic forms were

optional for participants, some participants may not have submitted forms or may have declined to

respond to certain questions. As a result, the following tables and figures do not necessarily reflect the

total number of participants.

Participant Age Range

Participants were given the choice of selecting from four different age ranges corresponding to the

MHSA categories of Children, Transition-Age Youth (TAY), Adults, and Older Adults. Of the 32

participants, a large proportion of participants were 25-59 years of age. The remaining seven

participants were 60 and older years of age (see Figure 9: Percent of Community Meeting Participants by

Age (n= 32)).

Figure 9: Percent of Community Meeting Participants by Age (n= 32)

Participant Gender

Of the 32 participants who filled out the demographics form, a large majority of respondents were

female (78%). The remaining seven respondents were male (22%) (see Figure 10: Percent of Community

Meeting Participants by Gender (n= 32)).

Figure 10: Percent of Community Meeting Participants by Gender (n= 32)

Participant Race/Ethnicity

Figure 11: Percent of Community Meeting Participants by Race/Ethnicity (n=32) indicates that majority

of community meeting participants who filled out the demographics form were White/Caucasian (70%).

25-59 78%

60 and older 22%

Female 78%

Male 22%



Thirteen percent of respondents were multi-racial. The remaining respondents identified as African

American, Hispanic/Latino, Asian/Pacific Islander, and American Indian/Native American.

Figure 11: Percent of Community Meeting Participants by Race/Ethnicity (n=32)

Participant Place of Residence

Figure 12: Percent of Community Meeting Participants by Place of Residence illustrates community

meeting participants’ place of residence by region. Of the 32 participants who responded to the

demographics survey, the majority of participants reside in West County (38%) and Central County

(31%). A smaller proportion resided in South and East Counties. The 12% of respondents who marked

Other did not specify their place of residence.

Figure 12: Percent of Community Meeting Participants by Place of Residence

6.5% 3.2% 3.2%

6.5% 12.9%

67.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

AfricanAmerican/Black

AmericanIndian/Native

Alaskan

Asian or PacificIslander

Hispanic/Latino Multi-Race White/Caucasian

Central 31%

East 16% Other

12% South 3%

West 38%



Community Engagement Results Overview

County-Wide Results

At the conclusion of focus group events, the facilitation team synthesized the results across age groups

and populations to develop findings that apply to the County’s mental health system as a whole. These

findings were presented at the community forums held at the end of March 2014 and at the April 3,

2014 Consolidated Planning and Advisory Workgroup (CPAW) meeting. Based on feedback from forum

participants, we refined these findings in between each meeting. Below are the consolidated findings

that represent overall results of community engagement activities.

Active and engaged stakeholder groups. Contra Costa County has a diverse network of active and

engaged stakeholders in the mental health system. Consumers, family members and loved ones, and

providers demonstrated their commitment to improving the mental health system in the community. At

many of the focus group events, there was overwhelming participation by different stakeholder groups.

Stakeholders came prepared to brainstorm ideas to close the gaps in mental health services, and the

discussion was passionate.

Programs that support and adapt to the needs of consumers. In all of our focus groups, stakeholders

discussed programs that serve as models for success in mental health services. Consumers felt that

many programs are responsive to their needs and honor their experiences in the mental health system.

Providers reported back about the innovative programs they have developed to provide comprehensive,

recovery-oriented care for consumers. Family members discussed their selfless efforts and shared

deeply about their experiences in supporting their loved ones through recovery.

Inconsistent experience of wellness and recovery. While

some programs and sites are recovery oriented, there is

an inconsistent experience of wellness and recovery.

Focus group participants from underserved cultural

groups identified programs lacking a “whole-person”

approach to wellness as a barrier to participating in

mental health services. In addition, different stakeholders

had very different accounts of how recovery oriented

I keep hearing the words “too high

functioning,” I had to go to speech

therapy. I couldn’t speak. I’m tired

of hearing this; it doesn’t mean

nothing is wrong. Deep inside

bombs are going off. I’ve kind of

jumped over here, here, and here.

I want to voice it.

-Central County Homeless

Adult Consumer



programs were, indicating that there is an inconsistent experience of wellness and recovery across the

mental health system. This was especially true for some consumers who believed that recovery is dis-

incentivized because services become less available as recovery is achieved, placing them at risk of

relapse.

Lack of consumer and family driven services. Participants

noted that services seem more available to consumers who

are better able to advocate for themselves and less

available for those who are less likely or able to assertively

seek services. Family members are relied upon as a critical

resource for consumers, especially in in cases of crisis, but

are not included in service or treatment planning.

Services that are collaborative and integrated across the

mental health system. Consumers, family members, and

providers all agree that the mental health system contains a

lot of valuable components, but the experience of the

system is disjointed. This increases the risk of people “falling

through the cracks.” For some participants, there was a

pervasive lack of knowledge about service availability and

frustration with the process to obtain needed services for themselves or a loved one. Participants said

the County needs to improve its partnerships with non-mental health providers such as the schools,

criminal and juvenile justice, and social service agencies.

Culturally competent services for unserved and underserved

groups. In every focus group event, participants acknowledged

that stigma of mental health and unserved/underserved groups

is a barrier to receiving services. We heard participants

emphasize the stigma of the Lesbian, Gay, Bisexual,

Transgender, and Queer (LGBTQ) community as pervasive

throughout the mental health system and in the community.

The LGBTQ community noted that a lack of trained

professionals on LGTBQ health issues is a significant barrier to

accessing services. Bullying and physical harassment was a specific concern of young people, especially

within the Transgender community, as a result of stigma. Although cultural-specific services are

available in certain settings, focus group participants suggested that they are not available across the

mental health system. Other cultural barriers to mental health services exist; for example, reliance on

telephone translation and the access line not trusted by some cultural backgrounds.

Lack of access to basic resources gets in the way of recovery. Despite the County’s best efforts to

ensure access to housing, benefits, transportation and other basic resources, there remains a significant

need for additional resources. Focus group participants offered these specific examples where

additional resources are needed:

We do LGBTQI cultural

competence training – we

could do more of it. We’ve

only done about 15 trainings

last year, but I want it to be

45 trainings.

– LGTBQ Provider

I don’t want to be handcuffed

so to speak in that I’m

mandated to live this way or

that way. You can lead me so

far. I don’t want to become

dependent on someone else in

doing something for me. What

happens if the funding stops

and I’m thrown out? I don’t

want them holding my hand.

You’ve helped me so far, what

would keep me going further?

– Central County Adult

Consumer



The shelter environment is difficult for those who are engaging in dual recovery.

There is a lack of single occupancy units compared to shared housing.

Lack of transportation is a barrier to receiving services.

Clothing, food, childcare, and income were all cited as significant needs.

Continuity and comprehensiveness of crisis specific services. For all age groups, focus group

participants described a lack of crisis supports before, during, and following a crisis event. Consumers,

family members and loved ones, and providers noted that there are minimal crisis services outside of

business hours that would help prevent or respond to a crisis. It was also acknowledged that the County

lacks comprehensive discharge planning and follow-

up support for consumers after a crisis event. High

utilizers of involuntary services, such as the hospital

and jail, experience difficulty in engaging in services

pre and post crisis. In addition, crisis-specific

resources for minors and young people were

reported as significant needs in the community.

Accountability to the MHSA and consumers served

by mental health services. Upon reflection and

discussion of the priority needs and strategies to

close the gaps at the Community Forum events,

participants suggested that there is a lack of

information and transparency to support data-driven decision making. Stakeholders specifically

requested to know the number and demographics of persons

served by MHSA programs, funding amounts for each program

and how those funds were spent, and the outcomes of

consumers in MHSA funded programs. Program outcomes and

evaluation that was inclusive of peers/consumers was another

specific request of stakeholders.

Develop a continuum of services that provides support at all

levels of recovery. Stakeholders reported specific suggestions on

how the County can develop a continuum of services that provides support at all levels of recovery.

Examples include developing career pathways for people with lived experience in and out of the mental

health system, and to maximize the use of wellness, community, and multi-service centers to expand

meaningful daily activities that promote engagement in services, recovery, and wellness.

The ability for us to connect people to

services right after that is almost

impossible so they can get the

medications and the services they

need. I think MH access is a really

slow process. We need something that

can respond to the urgency in terms of

the nature of this population – they

wait too long for psych assessments

and for medication assistance.

-TAY Provider

Where’s the context? Where’s

the data? Where’s the

information?

I want to see the data on what is

evidenced based. I want to see

what we’re doing that’s working.

-Family members



Consider ways to promote the meaningful inclusion of

peers and family members in the mental health system.

Focus group participants believed the County can do

more to promote the meaningful inclusion of peers and

family members in the mental health system. Stakeholder

suggested that CCBHS develop a Consumer Self-Advocacy

Training program and build upon Speaker’s Bureau type

activities (such as the Office of Consumer

Empowerment’s WREACH: Wellness Recovery Education

for Acceptance, Choice, and Hope) to help consumers

develop the skills to more assertively navigate the mental

health system. Focus group participants also noted that the number and roles of peer and family

providers can be expanded, especially in outreach and engagement, systems navigation, and crisis

response and follow-up. Specifically, peer and family member positions could be considered to address

gaps related to recovery, collaboration, integration, and cultural relevance. Additional services to

collaborate with and support families and loved ones who serve as primary resources for consumers in

recovery were also requested.

Strengthen the collaboration between the County, providers,

and other stakeholders. In order to address the disjointedness

felt by consumers, family members and loved ones, and

providers in the mental health system, focus group

participants suggested a number of ways to increase

collaboration and awareness of the County’s mental health

services. Providers suggested that the County develop formal

mechanisms for collaboration using Memorandums of

Understanding (MOUs) or contracts as leverage. Participants

suggested that the County develop a comprehensive

resource/referral guide for all stakeholders that includes a

service description, referral process, and eligibility criteria to increase people’s knowledge of the

services available. Participants also suggested CCBHS increase

mental health awareness for non-mental health professions (i.e.

school faculty and staff, probation officers, etc.) such as Mental

Health First Aid and Youth Mental Health First Aid, Applied

Suicide Intervention Skills Training (ASIST), Safe Talk, Crisis

Intervention Team (CIT) training, and more. Stakeholders also

believed that integration between primary care and substance

use services could be enhanced for all age groups, and

specifically for older adults. In addition, a stronger partnership

with law enforcement and the County’s Community Corrections

Partnership (CCP) was encouraged by participants to strengthen

Training on bullying [is

needed]. The school just

‘slaps kids on the wrist’ and

moves on. That’s not taking

care of the situation. One

killed pulled a knife on my

daughter on the bus and

they didn’t do anything.

– Central County Parent

We need to increase the

number of bilingual and

bicultural workers,

especially: Spanish, Farsi,

Arabic, and Southeast

Asian Languages… We

especially need trainings

that address cultural

competency with LGBTQI

issues.

– Children’s Provider

I’ve done this work. I’m not just

telling you something and blowing

in the wind - those are some things

I did to do advocate work. I’ve

done some case management. I

wake up every day to do

something to improve my life.


Adult Consumer



collaboration around AB109 (also known as “Criminal Justice and Public Safety Realignment”).

Promote a culturally competent and diverse mental health workforce. Focus group participants,

particularly those from underrepresented cultural groups, said that institutionalized stigma needs to be

addressed proactively by CCBHS via culturally relevant interventions. Stakeholders suggested that the

County consider non-traditional ways to allow access to core mental health services and increase the

number of clinical services available in cultural-specific programs. Other suggestions to address

institutionalized stigma were to increase public awareness through targeted media campaigns and

outreach in the community.

Increase access to basic resources such as housing, transportation, and entitlement benefits. Focus

group participants made the follow suggestions to improve access to basic resources:

Housing: Increase the availability of housing options from transitional through permanent

supportive housing. CCBHS should also consider a “sober shelter space” for those in dual

recovery. The County should also prioritize the development of affordable single occupancy

housing.

Transportation: Consumers requested that the

county increase access to transportation resources,

though no preference is given to a particular solution.

Consumers reported that the type of transportation (bus,

shuttle, van service, etc.) is less important than its

availability.

Partnership with Social Services: Providers and

consumers said CCBHS could strengthen its collaboration

with social services agencies to streamline access to

entitlement benefits.

Enhance the continuity and comprehensiveness of crisis services for all age groups and for high

utilizers of criminal justice and hospital systems. Consumers, family members and loved ones, and

providers prioritized the need to develop programs that

address the “revolving door” of Psychiatric Emergency

Services (PES) and the jails. Specific suggestions they

included are:

Intensive outreach to engage people that are less

able to advocate for themselves or are “difficult

to engage.”

Mobile crisis services to reduce inappropriate use

of jails/PES and increase recovery supports.

Discharge and post crisis follow-up services to

facilitate engagement with the mental health system.

Transportation should be written

into our [treatment] plan, like how

to get to mental health

appointments. Maybe shelter staff

should consult with mental health

staff to get things more

incorporated.

– Central County Homeless

Adult Consumer

One of the things that I noticed

throughout is the discussion is that

there isn’t enough support for

recovery after the crisis…It sounds

like we really need to talk about

the programming and what we can

do after that crisis. It seems to be

a huge gap for all ages.

– CPAW member



Specific requests were made by providers and parents of minors and young people to consider the

exploration of in-county children’s crisis and residential services. Family members and loved ones of

consumers strongly suggested and supported the implementation of AB1421 Assisted Outpatient

Treatment (also known as “Laura’s Law”) to address the needs of consumers who are difficult or hard to

engage, don’t readily participate in treatment, and have repetitive contact with the jails and psychiatric

emergency services.

Improve staff and provider professional development and prioritize hiring and recruitment of

bicultural/bilingual staff. Across all of the community engagement events, we heard that consumers,

family members and loved ones, and providers supported the further improvement and training of

mental health staff in the following areas:

Wellness and recovery-focused services

Engagement and welcoming environment (e.g.

customer service orientation)

Cultural competence and relevance

Collaboration and integration

Trauma informed care

HIPAA regulations

Consumers also requested that the County prioritize the hiring and recruitment of bicultural/bilingual

mental health staff that is reflective of the populations served.

What about staff development for

contracted agencies like on cultural

competency, etc.? Many CBOs don’t

have the money to get it, but if they

County can do that and open it up

to our providers that would be

helpful.

– CPAW member



Community Engagement Results by Population

Children System of Care

Parents, providers, and children’s mental health staff contributed to a series of in-depth discussions

about the children’s system of care in Contra Costa. Overwhelmingly, providers, staff, and parents all

agree that once enrolled in a program or with a provider, children receive a comprehensive array of

services that contribute towards their resiliency and wellness. However, common challenges that

parents with children receiving mental health services face include long wait-times in-between

appointments, a lack of culturally and linguistically competent providers, and inadequate supports pre

and post crisis. Focus group participants offered several strategies to address these gaps in mental

health services for children such as hiring additional child psychologists (especially those who are

bilingual and bicultural), developing more mobile or home-based services to increase entry into mental

health services, and training to non-mental health professionals on how to intervene in the event of a

crisis and where to go for help.

CCBHS continues to develop new and innovative programs, especially those that implement evidence

based and promising practices. Children’s providers and staff acknowledged that even with limited

resources, CCBHS is dedicated to enhancing the children’s system of care with new and innovative

programs and services. In particular, children’s providers are focusing on the integration of evidence

based best practices, such as Trauma Informed Care.

Once children are enrolled in services, parents are very satisfied with

the care and attention their children receive in mental health

services. Parents were supportive of the notion that once enrolled in

mental health services, their children received great care. Parents

reported that providers and mental health staff were very informative,

helpful in connecting them with

other services, and supportive to

parents and other family members.

Continuity and care coordination.

Focus group participants reported there is a lack of care

coordination, especially between medication management and

The staff are easy on

the kids. My kids enjoy

coming here [CCMH].

They like it and that’s

what makes it

comfortable. They’re

not in fear, they’re safe

and relaxed.

-Central County

Parent

The principal kept blaming

my daughter for a

meltdown she had and kept

asking her to do something

[different] that she wasn’t

capable of.

-Central County Parent



psychosocial supports. Parents discussed the importance of having the psychologist and psychiatrist

work together as a team. Parents noted the lack of mental health supports and awareness in the schools

as a particular concern.

Parent/family supports. For parents and families seeking services or coordinating between different

providers, focus group participants discussed the lack of navigation support from the County. Parents

found community-based providers helpful in their capacity to navigate certain services, but there is a

lack of navigation support between County mental health services and between County and CBO

services.

Awareness and accessibility to mental health services. Parents and

providers of mental health services discussed the lack of awareness of

the types of mental health services and the lack of accessibility to

services. In particular, parents discussed how difficult it was to know

where to go to get their children help when mental health problems

arose; parents reported that getting initial entry into the mental

health system is difficult. Providers spoke to the geographic and

transportation barriers to their clients receiving ongoing mental health

services. Some providers felt that services are too consolidated in only

certain parts of the County, and paired with a lack of transportation options, were difficult for parents or

family members to physically get to.

Crisis services continuum. Parents and providers both

agreed that more can be done to enhance the continuum

of crisis services for children. Pre and post crisis services

are especially difficult to navigate and access due to a lack

of information and awareness about what pre and post

crisis services are available. Specific requests were made

by parents and families to increase awareness with school

staff on how to both intervene in the event of a crisis and

how to refer a family to the County during a crisis.

Mental health workforce needs. Contra Costa County is a

diverse County with a variety of cultural and linguistic

needs represented by those seeking mental health services. As such, providers and parents from several

different cultural and linguistic backgrounds indicated that there is a lack of bicultural and bilingual

mental health workers. Other mental health workforce needs includes a lack of child psychiatrists and a

bilingual/bicultural (Spanish) child psychologist.

Enhance the continuity and care coordination of mental health services through increased

collaboration and decentralizing service delivery. Focus group participants suggested several ideas or

strategies to help enhance the continuity and care coordination of mental health services. Providers

We ended up going to

mental health services

out in Oakland because I

felt there was nothing

here that could help her.


The whole experience wasn’t very

pleasant when I was 5150’ed. The

staff weren’t horrible, but they

weren’t personable. They didn’t get

to know my name… They didn’t go

out of their way to help me at all. It

was a scary environment. They put

you in a little room… and that’s

scary.

-Central County Youth



noted that the lack of basic resources of consumers gets in the way of providing mental health

treatment. Focus group participants suggest enhancing the partnership between mental health and the

Department of Social Services to increase access to basic supports, e.g. food, clothing, housing, child-

care, etc. Providers also discussed the need for more opportunities to collaborate on mental health

services and suggested that the County can use Memorandums of Understanding (MOUs) or contracts

as leverage to facilitate collaboration. Finally, to increase access to children’s mental health services,

especially for working parents, both parents and providers suggested adding mobile services to treat

children in the home and expanding the hours of services beyond normal business hours.

Increase the amount of support to parents and family members. Parents and providers both

acknowledged the importance of having more supports for families with children accessing mental

health services. In particular, focus group participants suggested that the County recruit more family

partners/systems navigators to help parents seeking mental health services for their children. Parents

and providers also noted the importance of integrating consumers and family members into the mental

health system and supported the idea to involve consumers/family members in service planning,

delivery, and quality improvement (QI).

Increase awareness and accessibility to mental health services. Focus group participants spoke to the

difficulty in the initial entry into mental health services. To address this gap, participants suggested

enhancing the information about mental health services on Contra Costa County 2-1-1. More

comprehensive resource guides available at all County and provider locations on mental health services

would also increase information access at all mental health entry points.

Enhance the continuity of pre and post crisis

services. Increasing the support of consumers’ pre

and post crisis was a common theme throughout

the community engagement phase. For children

accessing crisis services, parents suggest that more

can be done to increase awareness and training

about crisis services and crisis intervention. Crisis

intervention training for non-mental health

professionals, especially in the schools, is needed

and Mental Health First Aid and/or Mental Health

Youth First Aid are evidence-based models to

achieve better crisis training. Families and parents

also indicated that they need more training on how

to help their children in the event of a mental health crisis. Providers and parents both believed more

pre and post crisis services for families are needed, especially support following a crisis event that could

be provided by a family partner. Providers and older children who participated in the focus groups

suggested that a separate crisis hospital or unit is needed.

Increase hiring and training of the mental health workforce. In order to meet the mental health needs

of consumers in Contra Costa County, focus group participants suggested that the County focus on

The second time I took my daughter to

the county hospital… They just put me

in a waiting room that was glass-

enclosed and locked… I knew nothing

about what was going on…I wish

someone would just come and talk to

you. I wish I could have stayed with my

daughter. I mean, I wish an exception

existed that, when appropriate, I could

stay with her.




hiring additional mental health workers. Participants made specific requests to increase the number of

child psychiatrists and bilingual/bicultural (Spanish) child psychologists. More bilingual/bicultural

workers are needed in general throughout the County. Providers also suggested that mental health

workers from different cultural backgrounds cross-train each other to increase their competency

working with consumers that have different backgrounds from their own.

Transitional Age Youth (TAY) System of Care

Strong network of community-based providers that are highly supportive of youth consumers. The

community engagement phase saw a large proportion of highly engaged youth and TAY providers

participating in the events. Youth felt that mental health service providers were highly supportive of

their own wellness goals and attentive to their mental health needs. TAY providers were also highly

engaged and demonstrated how their programs sought to adapt to the needs of their consumers.

TAY peer staff help consumers feel more welcome and engaged in services. Youth participants in the

focus group events discussed the importance of having peer staff in TAY mental health programs. Youth

felt peer staff help them speak openly about their recovery and that they perceived peer staff as role

models.

Activity-based programs promote wellness and recovery. Activity-

based programs that promote wellness and recovery helped youth

feel more welcome and less-stigmatized for seeking out mental

health services. For those youth that are engaging in TAY mental

health services, they appreciated the diversity and accessibility of

activity-based programming that taught them developmentally

appropriate skills.

Mental Health Awareness in the schools. Across all focus groups with youth and providers, participants

strongly agreed that there is a lack of mental health awareness and sensitivity in the County’s schools.

Youth and staff retold stories of bullying, harassment, and violence in the schools due to the stigma

attached to mental health and other issues that affect young people. TAY suggested that school faculty,

staff, and other students did not understand mental health; school staff and faculty particularly lacked

the skills to respond to mental health crises competently.

Awareness and accessibility to mental health services. Many youth and parents of youth discussed the

difficulty in accessing information about mental health services for TAY. Similarly, students and parents

discussed the lack of knowledge school staff and faculty have about County mental health resources.

Youth participants suggested the stigma associated with receiving treatment for mental health prevents

them from seeking mental health services in traditional treatment settings.

They keep me busy.

When I used to come

here, I used to run the

streets and do delinquent

actions. This keeps me

busy.

-West County Youth



Youth development approach across mental health

services. Youth focus group participants felt that

mental health services lacked a ‘whole-person’

approach to mental health. Youth face a broad range of

challenges as they transition to adulthood including

school, employment, and life-skills. Youth note that the

types of programs that integrate these various

components into an approach, i.e. Youth Development,

are needed. In addition, there are a lack of

opportunities for youth to develop these skills and

become peer staff.

Prevention and early intervention services. Focus

group participants discussed the need to continue and

or enhance activity-based programs that promote

wellness and recovery. In addition, providers and youth

strongly felt that there were a lack of therapists and

psychosocial supports for youth with mental illness to

prevent relapse.

Suicide prevention and intervention. Suicide

prevention and intervention skills are essential to the

friends and loved ones of people with mental illness;

suicide prevention is especially important to the TAY

age group. Focus group participants noted that there is a lack of regular training and supports in

developing the skills related to suicide prevention and early intervention.

Partner with the school districts to deliver trainings and resources on mental health to increase

awareness and accessibility to services. Focus group participants suggested that the County could form

stronger partnerships with the school districts to provide and enhance trainings that address mental

health awareness. Youth and TAY providers suggested Mental Health First Aid and Youth Mental Health

First Aid as training curriculums to give school staff and faculty the skills they need to recognize and

address mental health issues.

Develop stronger outreach to TAY in the communities and enhance access to mental health services in

non-traditional settings. In addition to increasing awareness of mental health in schools, focus group

participants said that increasing outreach to TAY is critical to promoting accessibility of mental health

services to youth. In addition TAY providers and youth participants made several suggestions to increase

access to mental health services. Participants suggested increasing the access points to mental health

services in non-mental health settings (schools, community centers, wellness centers, community

events, etc.) where youth are already present. In addition, youth participants suggested the County

Young folks need a space where they are

wanted and needed. [They need]

someone who can relate to what you are

going through and not telling you “you can

control it or you’re not trying hard

enough.” You need someone to

understand what you can and can’t

control with support.

-East County Youth

As a foster mom, what would be

really good for the county is to

provide more mental health care in

a short period of time for the kids

that come to us. When I get an

emergency placement, they don’t get

mental health services for months,

whereas I need them to be talked to

and assessed within a week.

-East County Parent



could work towards developing a smart-phone application for mental health services that would include

a comprehensive resource directory, live chat with a mental health representative or clinician, and a

calendar of community wellness events.

Enhance opportunities for youth to develop life-skills and to serve as peer mentors/staff. Youth

participants suggested that mental health programs for TAY continue to develop career pathways for

youth to serve as peer staff or mentors and to increase the accessibility of programs that promote

wellness and recovery. Programs that youth say are working are activity-based, focus on life-skills,

employment skills, and on adapting to the transition to adulthood. In general, focus group participants

emphasized the need for TAY mental health programs to take a ‘whole-person’ approach to promoting

wellness and recovery.

Increase the number of programs that focus on

wellness and recovery in order to prevent relapse. In

addition to increasing activity-based programming

discussed above, youth and providers say that

increasing the number and types of therapy and

counseling available to youth will help prevent

relapse. Participants suggest that the County should

support therapy and counseling approaches that also

promote a family-inclusive approach, noting the

importance of increasing the resiliency of family

members supporting youth.

Increase targeted trainings on suicide prevention and intervention skills in the community and

schools. In order to address the lack of trainings that address suicide prevention and intervention skills,

TAY providers and youth felt strongly that more trainings across the County should be offered that

address suicide. Participants suggested models such as Applied Suicide Intervention Skills Training

(ASIST) and SAFETalk as evidence-based curriculums the County can use to train the community on

suicide prevention and intervention. Youth Mental Health First Aid was similarly supported by

participants as necessary trainings to conduct with mental health system stakeholders.

Adult System of Care

Adult consumers across Contra Costa County and their mental health providers shared similar

experiences in accessing and navigating the County’s public mental health system. Consumers and

providers agreed that once consumers and family members are able to receive services through

community-based organizations, the experiences have generally been positive and productive, however,

accessing and interfacing with County-provided services has been more difficult.

I like 1:1 [therapy] because she’s

[the therapist] is focused on how I

feel and how I can work on it from

a different perspective. They [the

County] should add counseling with

the parents. The counseling with

parents can help them see from

someone else’s perspective what

they need. I would love that.

-East County Youth



When available, system navigation is helpful and

appreciated. When there is a provider or peer to

help consumers navigate the mental health

system, consumers and family members are

better able to access and engage in the services

they need.

Community programs provide social support.

Consumers praised the structure of community

programs and the social support found in

participating in community-based organizations.

CBO case managers are caring and helpful.

Consumers praised the case managers and case

workers provided by several community-based

organizations. The appreciated the dedicated one-

on-one counseling and care coordination.

Employment readiness/opportunities for

consumers. Consumers expressed the difficulty of

obtaining employment that would allow them

adequate means. While some have been able to find part-time and/or entry-level work, the wages are

high enough to disqualify them from receiving supplemental security income, but not enough to meet

their daily living needs.

Processing time to access entitlement benefits.

Stakeholders felt that there were disconnects between

CCBHS, CBO services, and social services. This

disconnect often resulted in a gap of services during

which consumers are waiting for benefits to be granted

(e.g., food stamps, SSI, housing eligibility, Medi-Cal

enrollment, etc.) while having reached the expiry or

maximum level of service in another area.

And you get frustrated when you’re calling

to get help and you’re at your weakest

already, feeling at your wit’s end and

couldn’t get connected to the proper

person. [The Navigator] was there to help

you through and get to the community

help. She was there to give you that extra

push to help us stay standing.

– West County Adult Consumer

And I left the group at one point, but

[the provider] was on the phone, calling

me, leaving me messages, made me

come back and helped me. That’s how

powerful that group is. We need more

groups and communities like that

because it helps and it speaks volumes.


I understand because you got people

coming in, but…if you still have SSI

pending and your time is up at the

shelter—what, you let your time run

out and go back to the street? Why

put me back on the streets when I’ll

use on the street?

– Central County Adult Consumer



Recovery focus across all adult mental health programs. Both

consumers and providers felt that in order for consumers to

access County services, they needed to have chronic and/or

serious mental illness in order to be connected to any County

service. Further, the consumers expressed that once they were

able to receive the adequate dosage of medication to reduce

symptoms, they were switched to medication management

services only and/or were terminated from program without

referrals for follow-up services.

Warm and welcoming environment. Both consumers and providers reported that while some clinics

and programs are able to provide warm and welcoming environments, some locations, especially

County clinics, have uninviting atmospheres and discourteous staff. Additionally, coordination amongst

the personal service coordinators can be an issue. Consumers reported needing to re-tell their story

multiple times and that it can be difficult to get all team

members to come to a consensus on the plan for

treatment.

Mental health workforce. Consumers, family members,

and providers agreed that providers are overburdened

with the current distribution of work. This has resulted

in consumers receiving impersonal care, both

consumers and providers being unaware of services

available, and providers being unable to ensure client

handoffs.

Crisis services in West County. Currently, the only County

facility that will treat adults in crisis from West County is the

County hospital in Martinez. Clients discussed the burden to

travel to Martinez when they are in crisis and believe there

should be a place to go that is located in West County during

a crisis event.

Develop programs to increase consumer employment readiness and

opportunities for employment. Stakeholders suggested partnering

with local businesses to create more employment opportunities for

consumers. Additionally, CCBHS should work with CBOs to enhance

employment readiness programming for consumers, providing them

with professional development and basic technical skills.

They just want to get you in, get your

money and get you out in 15 minutes

or 4-5 people who have the same

time apt and they’ll give you a 5

minute window before they

reschedule you. You can be a minute

late and they won’t take you.


I feel like there has to be a

traumatic experience for

people to receive to

counseling. Why does it have

to go that far? When people

that are witnessing crimes,

they need counseling too.

– East County Provider

The hospitals are really far away.

I’m using Kaiser Hospitals when

I’m supposed to go to Martinez.

It’s crazy that I’d have to go to

Kaiser.

– West County Homeless

Adult Consumer

I would like to see a

partnership between CCBHS

with local workplaces like

Home Depot, Wal-Mart,

Lowe’s that allows people who

are stable and can work, to

allow them to work.

- West County Family

Member



Establish stronger partnership with Social Services to decrease time process entitlements. To address

these issues, CCBHS could strengthen linkages with social services to ensure timely benefits processing

and assistance. The goal of such a strategy is to decrease wait times for issuing entitlements and ensure

consumers’ basic needs are met as they work

toward recovery.

Increase the recovery focus across all adult

mental health programs. Focus group participants

expressed the need for services to be more holistic

and focused on consumers’ wellness and recovery,

as opposed to the current approach of triage,

medication, and symptom reduction. Providers

and consumers believed that CCBHS could adapt a

strengths-based and community-driven approach

to recovery planning and wellness promotion. Such

a process would involve consumers and family

members in program planning, implementation, and evaluation.

Create a warm and welcoming environment through workforce improvements. Consumers, family

members, and providers agreed that overall customer service could be improved. In addition to

providing regular customer service training and professional development to program staff, CCBHS

should also increase the number of peer mentors/providers to help consumers and family members

navigate the large CCBHS system.

Increase the number of peer mentors/peer providers. To help

alleviate provider burden, CCBHS could increase the number of

peer mentor/provider positions and enhance consumer self-

advocacy training so that consumers can access the appropriate

mental health services more easily, complete insurance forms,

and schedule appointments.

Develop crisis-specific services in West County. A possible solution addressing this need would be for

CCBHS to explore a partnership with Kaiser Permanente to provide crisis intervention and treatment in

West County. Consumers reported that the Richmond Medical Center would be easier to access in times

of crisis.

Older Adult System of Care

Older adult consumers across Contra Costa County and their mental health providers shared similar

experiences interfacing with the County’s public mental health system. Consumers and providers agreed

that services for older adults have been effective and generally easy to coordinate. However, the

There are so many factors in life

affecting your mental condition. If you

just want to define “Mental Illness,” it’s

very different from “Mental Health.”…

Every time you [the County] encourage

the client to come in, you run down a list

of symptoms and never running a list of

strengths. If you talk about strengths, you

can promote wellness and promote

Mental Health.

– Adult Provider

Have a person working here

to provide 1 on 1 to help you

with [system navigation].

– West County Homeless

Adult Consumer



stakeholders reported a lack of integration between mental health, physical health, and alcohol and

other drug services.

Socialization programs are engaging and effective in

promoting wellness and resiliency. Consumers reported

that social activities, such as art classes, field trips to

neighboring areas, and eating together, brought peers

together and promoted socialization.

Services are available and are individualized. Providers

reported that due to the smaller consumer population,

they have been able to provide adequate and timely

services for older adults. Further, they noted the

importance of providing specialized services for older

adults as they have different needs from general adult

consumers.

Linkages between physical and mental health. Older adult providers expressed frustration arranging

care for their consumers between CCBHS and their primary care physicians. Providers stated that there

was a lack of integration between the service departments.

Social supports. While consumers appreciated the socialization

programs available for older adults, they felt that additional and

varied programming was needed.

Continuity and care coordination. Older adult

providers shared that in addition to feeling like

mental health, physical health, and AOD work in

silos, they also experienced difficulty arranging care

across services for shared consumers. This is a

marked difficulty for providers caring for

consumers with dementia and other cognitive

problems.

I really like this program, I have

something to do. I get to make

friends from other sites, I get to

meet people. I enjoy the Spanish

class a lot. I have learned quite a

bit.

– West County Older Adult

Consumer

Timely, expedient service.

Sometimes, we can see people in

the moment if it’s an emergent

situation, or in a week, two days,

three days from now. That may

change as our census grows higher,

but we work well with board and

cares and residential places.

– Older Adult Provider

I do not have anyone right now.

I have out lived them all. I have

to seek out some support.

– West County Older Adult

Consumer

There needs to be a look at also how

‘compliant’ patients are and how those

people are affected by the medication

they’ve been taking for a long time.

Lithium killed my kidneys. And then

when I had surgery, my doctor cut off

one of my psych meds and it [nearly]

killed me… I was 5150’ed on all three

grounds and I almost got fired from

my job.

– Central County Older Adult

Consumer



Inclusive treatment approaches. Older adult consumers

shared that they do not feel included in developing their

case management or direction of services. They expressed

that the experience often resulted in them halfheartedly

following the providers’ directions which they did not

always agree with.

Competent services for older adults with co-occurring

disorders. Providers expressed a need for specialized and

targeted services for older adults with co-occurring

disorders, especially for older adults engaged in both

mental health and AOD services. The current residential

and sober living environments are not age appropriate as they

combine young adults and older adults with a one-size-fits-all

strategy.

Roles and responsibilities. Providers shared that is not

functional or appropriate for case managers to also act as

money managers for older adult consumers. This creates

an unequal power dynamic that could harm the provider-

consumer relationship.

Develop stronger linkages between physical and mental health. To initiate collaboration between

mental health and physical health service providers, CCBHS, can develop cross-trainings for mental

health and physical health staff to better assess and support

consumers with dementia and mental health problems.

Additionally, CCBHS could increase wraparound services and

expand home-based supports, especially for consumers living

independently in the community. Further, CCBHS could

explore ways that mental health and physical health providers

could work together to increase support for integrated

medication management.

You want the person to

cooperate and you also have to

participate back so it’s

reciprocal. So when you have

people to come out, you want

people to partner with you, so

you work as a team.

– Central County Older

Adult Consumer

There are no drug and alcohol

services. We can do our best to

be competent with people who

have dual diagnosis. Our 70-

year-old alcoholic doesn’t want

to go to a place with a 20-year-

old meth addict so they just

drink themselves to death.


It causes a barrier for the case

manager and makes the patient

hate them because they can’t

afford $20 or they can’t be

honest because you’re managing

their money and you have some

much power over them. It’s a

huge amount of control over

their lives.


Quarterly meetings between the

mental health and the physical

health side and facilitate better

communication between the

two sides. It feels like everyone

is in their own little silo.




Continue to offer programs that increase social supports. To

address consumers’ need for additional and varied social

supports, and to ensure that there are enough services as the

population grows, CCBHS could increase the array of activities

that support socialization and physical activity among older

adults. Additionally, CCBHS could increase access to therapy

and counseling, especially for consumers facing issues of aging

and grief.

Enhance collaboration with physical health and community

providers to increase continuity and care coordination. In a

health system as large as Contra Costa County’s, it may be

difficult for individual providers and CBOs to initiate and sustain collaborative relationships across

practices. The County should develop mechanisms that enhance and support enhanced collaboration

among service providers.

Develop more inclusive treatment approaches through staff

training. To develop and practice more inclusive treatment

approaches, CCBHS could increase training support for providers

on how to create a partnership with older adult consumers.

Additionally, older adult consumers requested education and

support on how to

partner with

providers and work

together to identify individual needs and supports.

Develop Older Adult specific services for consumers with

co-occurring disorders. CCBHS could develop a targeted

program for older adult consumers with co-occurring

disorders to ensure that the level and appropriateness of

services is adequate. This is another strategy to enhance

linkages between mental health, physical health, and AOD

services.

Define roles and responsibilities for certain staff. CCBHS could consider separating case management

and money management responsibilities or explore ways to provide additional checks and balances.

Buy a plot like Rossmoor and

have that continuum of

services for people.

Neighborhood activities,

lectures, enrichment, travel,

exercise, pools, good nutrition,

organic local products, like

the CCC Cafes...


Have them work alongside

us and go out and see the

reality, rather than a

training where they can veg

out.


There needs to be education.

When we have meetings with

AOD services, they tell us that

older adults don’t use drugs

and alcohol. They said, “That’s

odd, I thought people would

die if they used drugs when

they’re 60.”




People Experiencing Homelessness

Homeless programs are predominately staffed by peers/people with lived experience. People

experiencing homelessness in our focus groups showed appreciation for how well homeless programs

integrate peer providers and people with lived experience as staff.

Resident counsel to provide opportunities for consumers to shape programs/services. Focus group

participants from the Brookside and Concord shelters identified the Resident Counsel as an asset to

homeless programs. Through the Resident Counsel,

consumers can provide their input on shelter activities,

programs, and services that are offered on site.

Healthcare for the Homeless facilitates access to

county services. Shelter residents who participated in

the focus group events said that the Healthcare for the

Homeless Program helps facilitate access to county

mental health and health services. Participants liked

having nurses, therapists/counselors, and other support

medical staff on site to triage their needs and link them

with other county programs.

Welcoming environment throughout the mental

health system. People experiencing homelessness

identified the lack of a welcoming environment at

the shelters and mental health service provider

locations as a significant gap in the mental health

system. Participants discussed how staff at various

locations do not openly greet consumers or

proactively interact with consumers and appear to

lack a sincere interest in or support for their

recovery.

Recovery orientation of mental health services.

Focus group attendees emphasized that mental

health treatment often consists of crisis and

medication management, but lacks sufficient

They’ve streamlined the

appointments, so you can press a

number to get to the

appointment desk instead of the

run around. Being able to leave a

message for the psychiatrist and

get a call back, you can get ahold

of a nurse for medications and

set that up if you can’t get to the

psychiatrist.


Adult Consumer

It’s harder for us. The one that gets

high and [acts] over the top… and

[then] they’re like, “I got my

housing!” You want to know how? Be

stupid, be ratchet, be off the hook do

all the wrong things and they will help

you. That is what gets you out of this

place.

The people who won’t follow the rules

[they] need to get out of here and get

them the help. Why is that working?

That doesn’t make sense.

-Central County Homeless Adult

Consumers



support for consumers to achieve their recovery goals. In addition to a recovery focus, participants

described that mental health services lack a wellness and whole-person approach to care.

Continuity and care coordination of mental health services. Similarly to other groups that participated

in community engagement activities, people experiencing homelessness described a disjointed

experience in navigating different mental health services throughout the system. People experiencing

homelessness also described a lack of services that prevents homelessness for those who are at-risk,

difficulty accessing benefits in a timely and efficient manner, and a lack of continuity in their case

management across housing settings and mental health providers.

Services for co-occurring disorders. The homeless shelters

in Contra Costa cater to a wide-range of people

experiencing homelessness with complex co-occurring

mental health and medical problems. Specifically, people

experiencing homeless identified that there is a lack of

services that address co-occurring mental health and

substance use. Therapists and counselors to support those

with co-occurring disorders are infrequently available and

their slots fill quickly on days they rotate through the

shelters. Co-occurring services was identified as a need for

both Adult and TAY populations experiencing

homelessness.

Access to housing. Overall, people experiencing

homelessness identified housing as a need. Participants identified the lack of single occupancy units,

sober shelter environment separate from the wet shelter, and TAY shelter beds, as an unmet need in

Contra Costa County.

Enhance the welcoming environment of the mental

health system through staff training. Focus group

participants suggested several different types of staff

training to encourage a more welcoming environment at

mental health service locations. Training suggestions

included customer service training, professional

development training, and confidentiality training for all

mental health staff.

I was waiting on my daughter

to arrive and I’m just standing

by them, and they said, “Nosy

bitch you need to move

away.” I wasn’t doing anything

but waiting for my kid. I

wanted to write her up. You

have to see and know what

the problem is before you can

correct it.


Adult Consumer

One of the things as a

recovering alcoholic, we’re a

wet shelter. You can’t use in

the facility, but they can drink

outside and come in blitzed.

As a recovering alcoholic it’s

really hard. Drug and alcohol

counselors need to be

available all the time.

-West County Homeless

Adult Consumer



Increase the recovery oriented nature of mental health

services through intentional program and staff support.

People experiencing homelessness described mental health

services as needing to be more whole-person centered, and

wellness and recovery focused. In order to accomplish this,

incorporate more wellness and recovery supports such as

counseling and WRAP in addition to medication

management.

Enhance the continuity and care coordination of services by

forming stronger partnerships with other departments.

Similarly to other focus groups, people experiencing

homelessness also felt that the mental health system is

disjointed. In order to create a more continuous system of

care, participants said to increase access to services for those

who are at-risk of homelessness, case management, and benefits assistance as early as possible.

Increasing the integration and collaboration of multidisciplinary teams and enhancing collaboration with

Social Services are essential components to achieving continuity and care coordination.

Develop targeted programs for homeless adults and transitional age youth (TAY) that address co-

occurring disorders. To address the lack of services that address co-occurring disorders, focus group

participants indicated that more therapists and counselors that treat co-occurring disorders should be

hired and staffed at homeless shelters and other sites. Additionally, more supportive housing options

need to be created for Adult and TAY homeless consumers with co-occurring disorders.

Increase access to safe, supportive, and stable housing along the

housing continuum (emergency, transitional, and permanent).

Focus group participants said that the County should invest more in

increasing the number of available beds and single-occupancy units

of available housing. Increasing available beds at TAY homeless

shelters throughout the County was a particular concern with TAY

providers. People in recovery from co-occurring disorders felt that

the County needed to develop a sober shelter environment

separate from the wet shelter. In addition, focus group participants

either experiencing homelessness or who have experienced

homelessness in the past feel that the County needs to develop a

protocol to determine length of stay in transitional housing on a

case-by-case basis that takes into account an individual’s progress

They need staff with lived

experience that is stable and

can be employed… How do I

tell my case manager that I

wanna go out and use and

they never used drugs before

so they don’t even know what

I’m experiencing right here?


Adult Consumer

[There should be] housing

specialists to help find you

housing, mental health

workers, vans to pick people

up, washers, meals,

showers…


Adult Consumer

You can’t take a one size

and fit it on everybody and

think that everyone will

succeed. And then give

them a set amount of time

before you push them out

the door. How do you help

someone when you don’t

address the issue that got

them here in the first place?


Adult Consumer



towards their recovery goals.

Latino Community

Community programs provide social support. Consumers

praised the structure of community programs and the

social support found through participating in community-

based organizations. Focus group participants felt that

providers partnered with them and their families to

understand the challenges that they faced every day.

Bilingual/bicultural staff capacity. Participants reported a

lack of bilingual services that presented many challenges,

including restricted access to services, reduced awareness

of service options, and inability to participate in wellness

and recovery activities due to language barriers.

Participants also reported that the lack of staff cultural

competency played a large role in how much they

engaged in services.

Mental health service awareness. Participants reported

knowing of few services that could help them, especially if

they did not quality for Medi-Cal. Providers also reported a

lack of awareness of outside resources for appropriate

referrals.

Mental health stigma. Participants felt that there was

great stigma and lack of understanding about mental

health and available services in the Latino community.

Their discussion revealed a lack of understanding about

mental health and the varied services provided for

mental health.

Continuity and care coordination. In addition to

needing more bilingual providers and staff to help

consumer and family members navigate the system and

They give us information on all

the services available in the

community and also

information about all programs

available. And being with other

families with the same

problems… going through the

same things and they

[providers] want to learn more

[about] what distracts us from

the problems we have.

– West County Latino

Consumer

My doctor told me that the reason

told me the reason he was sending

me to Familias Unidas was because

you don’t have Medi-Cal and there

are no services in Spanish in the

County Clinic.

– West County Latino Consumer

One of the problems is culturally

that Latinos, though most are

depressed, but we don’t want to

accept that because we don’t want

to be seen by a psychiatrist.

Its machismo and we don’t want

to admit that seeing a psychiatrist

would mean that we are locas.

– West County Latino Consumers



receive adequate care, consumers reported a need for better follow-up and care coordination. Focus

group participants discussed barriers to getting appointments for different mental health services, a lack

of follow up care, and supports for family members who care for their loved ones in recovery.

Access to mental health services. Participants reported

that it was very difficult to find and receive services.

Further, family members reported a need for more

accessible and more adequate services for family

members to provide necessary assistance to their loved

ones who have mental health issues.

Increase bilingual staff capacity through hiring and

recruitment. One of the clear needs expressed by

stakeholders was that of having a bilingual child

psychologist on staff in addition to increasing the staff’s bilingual and bicultural competency. To further

support this development, CCBHS may also increase training and support for bilingual/bicultural staff in

evidence-based mental health practices. Additionally, CCBHS might consider enhancing access and the

use of in-person interpreters and translators.

Increase mental health service awareness. CCBHS might

increase service awareness among stakeholders by

increasing community resource information list in 211

and developing comprehensive guides to mental health

resources in the County in public and high-traffic

locations, such as the internet and community centers.

Address mental health stigma through community

outreach and education. Stakeholders cited a large need

for outreach and education in the Latino community.

CCBHS could conduct greater outreach to these

communities and provide education about mental health to

those who are linguistically isolated and those who are

undocumented. Such information and notification of services

could be diffused throughout the Latino community through

CBOs targeting the Latino population.

Enhance continuity and care coordination through stronger

partnerships. To provide smoother transition of services,

CCBHS could work on enhancing linkages between mental

health, social services, and physical health agencies. Further,

CCBHS may consider enhancing linkages between these

There’s no psych services or

appointments or therapy.

Everyone should have access to

these services and supports. You

can call and they can give you an

apt with a psychologist, but it

takes a long time, minimum 25

days to a month.

– East County Latino Family

Member

Have flyers and pamphlets that

are bilingual in Spanish language

so that families know where and

how to find services. Because we

go to trainings and there is

someone interpreting there, but

the flyers are given in English.

– East County Latino Family

Member

Educate all parents what it

means for a student to have

special needs—not just the

parents of that children.

Help families identify the

differences between

misbehavior and special

needs.

–West County Latino

Consumers



agencies and school districts as Latino families perceive schools as trust sources of information receive a

lot of information from schools.

Increase access to mental health services. Participants

reported that it was very difficult to find and receive

services. Further, family members reported a need for

more accessible and adequate services for family

members to provide necessary assistance to their loved

ones who have mental health issues.

Asian & Pacific Islander (API) and Native American Communities

This West Contra Costa County focus group had participants from both the Asian & Pacific Islander (API)

and Native American communities present. Focus group participants noted that resources and

awareness for domestic violence, mental health stigma, and the bilingual/bicultural capacity of staff as

gaps in mental health services for the API and Native American populations. Consumers and providers

present at this group suggested the County develop community-wide initiatives to increase awareness

and develop resources that address domestic violence, develop a comprehensive campaign that

addresses mental health stigma in all communities, and increase the hiring of bilingual/bicultural

workers that are representative of the consumers they serve.

Personal Service Coordinators (PSCs) are essential to

accessing a continuum of mental health services and

supports. Focus group participants felt strongly that

PSCs were essential to accessing mental health services

and a wide variety of other supportive services such as

housing, primary care, and wellness activities.

Community based organizations (CBOs) that reflect

the communities they serve provide a safe space for

marginalized and underserved consumers. We heard from focus group participants about the

important role CBOs have in immigrant communities, Native Americans, and other underserved groups.

Without these organizations, focus group participants said, many consumers would forgo reaching out

for help in a crisis event and potentially risk their lives by staying in an unsafe situation.

Place counselors/therapists in the field,

at places where residents go on a

regular basis—this both increases

visibility and access to service and

potentially serves to reduce stigma in

the community.

– West County Latino Consumer

I can contact my worker, I work with

him one day a week, gets me

around, helps me get out to meet

people or another company, like a

family, he listens to me, he takes

care of a lot of people, my manager

was promoted but they had me

with another provider.

- API Consumer



Resources and awareness about Domestic Violence

(DV). The API and Native American communities were

concerned that there is a lack of DV resources in Contra

Costa County. Focus group participants even recounted

calling the County’s DV warm-line and receiving no

answer and no follow up from a phone operator.

Participants stated that their communities lack DV

awareness.

Support for newly immigrated parents and youth. API focus

group participants were especially concerned about the lack of

mental health and social supports for newly immigrated

parents and youth in Contra Costa County. Participants stated

that youth to join gangs for protection in the absence of other

institutions that create community and social cohesion.

Mental health stigma. Both the API and Native American focus

group participants believed their communities face significant

stigma around mental health. They reported that stigma was

getting in the way of people talking about mental health and

accessing mental health services.

Bilingual/bicultural capacity of mental health staff. API focus

group participants in particular described a lack of mental

health workers that spoke various Asian languages representative of the communities in West Contra

Costa County. Both the API and Native American focus group participants described a lack of mental

health workers that are reflective of their own cultures.

Develop community-wide interventions that increase DV

awareness and resources. Focus group participants from both

API and Native American communities discussed the

importance of developing DV awareness through initiatives

that address the whole community. Addressing the whole

community and identifying leaders within the community that

I have friends suffering from

domestic violence, but no services

out of Contra Costa. What to do?

No one answered the call, too late.

She died.

- API Consumer

Domestic violence hotline…Why

give out numbers if no one is going

to answer the phones?

- API Provider

Youth have a real challenge to

seek services [for] refugee

parents; [they are] not sure

how to protect themselves or

the teenagers… This drives

many to gangs for protection.

- API Provider

EPSDT program, under federal

guidelines, pulls student out of

classroom [and] this is

stigmatizing and it does not

help the kid get well.

- API Provider

Maybe we can do the outreach

that allows us to give information

more discretely, we know it has

happened, but it is not ok to talk

about it\domestic violence-

Vietnamese, Taiwanese, Lao,

need to be able to talk about.

- API Provider



can discuss DV related issues is a much safer way of increasing awareness rather than singling out

individuals for intervention. In addition to developing community-wide DV awareness initiatives, the

County should increase its oversight of the DV warm-line to ensure that the phones are being answered

and cases are followed-up on in a timely manner. DV resource materials should be distributed with

discretion; focus group participants discussed the danger especially women face if they are found with

DV branded materials.

Increase support for newly immigrated parents and youths through alternative mental health

services. API and Native American focus group participants suggested that more County support is

needed to increase access to alternative mental health services. In particular, newly immigrated parents

and youth and the Native American community do not trust traditional mental health services and must

be engaged in other ways – through clubs, social gatherings, or community events – to reduce the

stigma associated with mental health. API focus group participants suggested that programs need to

offer newly immigrated youth a sense of safety and protection as an alternative to joining local gangs.

Increasing access to mental health services in non-traditional settings like community centers is

imperative to these efforts.

Create a community-wide campaign that addresses mental

health stigma. Both API and Native American focus group

participants discussed the need to decrease stigma and

increase awareness about mental health. One focus group

participant suggested that the County develop an

advertisement campaign with posters on bus stops, grocery

stores, community centers, provider sites, and elsewhere that

depict people in recovery from all ages and cultural

backgrounds. This ensures people know mental health can

affect anyone in the community and decreases feelings of

isolation from those afraid to seek help for their mental

health.

Increase the number of bilingual and bicultural mental

health workers. Although County mental health services offer

the language line and video conference calling for consumers

who need it, focus group participants said it is difficult for

people from the API and Native American communities to

trust someone through a machine. Face-to-face interaction

with a provider is essential and the County should prioritize the hiring of bilingual and bicultural workers

to meet the needs of culturally diverse consumers.

There need to be

advertisements and posts on

Bus shelters, BART, AC transit,

public places, bus shelters,

with different faces of people

where you cannot pick out the

person who has a mental

health issues. Use people of

different ethnic backgrounds,

ages, etc.

-API Consumer

Service providers have to open

their doors for young people

to help de-stigmatize “mental

health.”

-Native American Provider



Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) Community

Stakeholders requested a focus group event that target Lesbian, Gay, Bisexual, Transgender, and Queer

(LGBTQ) consumers from across Contra Costa County. Consumers reported that there is a lack of trans-

capable services, institutionalized LGBTQ stigma, and a need for additional family supports. LGBTQ

participants suggested that through additional staff training, increasing LGBTQ competent providers,

and developing more family-inclusive approaches to mental health services can help close the mental

health gaps.

Providers create a safe space for LGBTQ consumers. Focus

group participants felt that LGBTQ providers create a safe space

for them to be themselves, explore their gender, and meet

other queer people.

Trans-capable services. Providers and consumers of mental

health and LGBTQ services identified a need for more services that are capable of serving people who

are transgender. Specifically, participants note how people who are transgender face deeper stigma due

to providers’ lack of understanding about the fluidity of gender identity and the distinction between

sexuality and gender, in general.

Cultural competency for the LGBTQ experience. Focus

group participants identified that the lack of cultural

competency/humility/compassion within the mental health

system prevents providers and mental health staff from

understanding the LGBTQ experience.

Family inclusiveness and supports. Providers and

consumers discussed how there are not enough resources

for parents to engage with services and supports alongside

their LGBTQ children. This lack of support increases the risk

for rejection when coming out and compromises the

potential safety of the consumer.

Mental health and LGBTQ stigma within non LGBTQ-

specific services. Although there are providers that target

the LGBTQ population, outside of those specific programs,

LGBTQ stigma is still pervasive across the County. There is a

lack of education and awareness among mental health and

I enjoy coming because you

get to express a different

side of you - gender identity,

gender expression, sexuality.

I can express to a side of me

that you couldn’t express to

the outside world.

-LGBTQ Consumer

How can MHSA address the

pathology of the system and its

fears of the LGBTQ community?

We need to switch the attitude

from viewing the gender identity

as the problem to systematic

solutions.

-LGBTQ Provider

As soon as the crisis becomes

specific to a person who is

LGBTQ, [the consumer] is sent to

Rainbow even though Rainbow

services do not fit the full needs

that were assessed for the

individual.

-LGBTQ Provider



non-mental health staff about LGBTQ issues and mental health resources for people who are LGTBQ.

Mental health workforce training for non-mental health staff. Providers said that they do provide

training to mental health staff on LGBTQ competence, but there is a lack of resources to expand those

trainings into parts of the county where it is needed the most.

Increase the number of providers who can provide trans-capable services. Participants suggested that

the County conduct focused outreach to identify and retain service providers that are capable of serving

the transgender community to be part of the mental health system.

Increase the LGBTQ cultural competency of mental health

staff through training. Participants from the LGBTQ

community and LGBTQ providers noted that mental health

staff and providers should receive more training on LGBTQ

cultural competency. LGBTQ cultural competency training

should include increasing the awareness of providers about

the experience of people who are LGBTQ in the

community. In addition, focus group participants strongly

emphasized the need to make all mental health forms

LGBTQ inclusive.

Increase supports for family of people who are LGBTQ. Providers spoke to the potential harms

especially youth face when coming out to their family and suggest that the County develop programs

that are more family inclusive. Family-inclusive LGBTQ programs could address rejection reduction and

provide a safe place for LGBTQ youth. Focus group participants also said that CCBHS should provide

more counseling services available for consumers and their families and loved ones.

Address LGBTQ stigma through cross training and developing LGBTQ competent core mental health

services. Providers and consumers noted that more training to reduce LGBTQ stigma is needed for

providers of core mental health services, crisis services, and outpatient services. Education needs to be

provided to staff on proper protocols for appropriately triaging mental health care for LGBTQ consumers

in crisis. Cross-training providers and core mental health staff to increase the capacity and knowledge

around mental health services and LGBTQ competency is another form of training the county could

facilitate.

Increase training for non-mental health staff. In addition to

reducing stigma and increasing competency within core

mental health services, focus group participants suggested

that there needs to be more training within the community

across Contra Costa County to help increase awareness

about LGBTQ issues. Focus group participants said to

increase peer-led outreach and education to schools,

There needs to be better

language used on applications

and paperwork for mental health

services that is more inclusive.

Staff need to know how to use

language that is respectful.

-LGBTQ Consumer

[The County needs] advocacy

training for people who have lived

experience. They need to develop

a program that trains peers to be

advocates within the mental

health workforce.

-LGBTQ Consumer



incorporate a LGBTQ component to Mental Health First Aid and Youth Mental Health First Aid, and to

enhance the connection between CCBHS and Gay-Straight Alliance organizations. Within the schools,

the County should help facilitate a stronger partnership with school faculty and staff to reduce bullying

and to consider a youth-led speakers bureau.

Family Members and Loved Ones of Consumers

We conducted an additional focus group for family members and loved ones of mental health

consumers that included significant participation from the National Alliance on Mental Illness (NAMI)

Contra Costa County. Family members and loved ones of consumers felt that the mental health system

lacked the continuity and comprehensiveness of crisis services as well as a warm and welcoming

environment to both consumers and family members. In order to address those gaps, focus group

participants suggested that the County increase crisis services, especially post crisis services such as

intensive follow-up care and the implementation of AB1421 (also known as Laura’s Law), and find

opportunities to increase the meaningful involvement of consumers and family members throughout

the mental health system.

National Alliance on Mental Illness (NAMI) serves as a strong network of support for parents and

families of mental health services consumers. Participants in the Family Member and Loved Ones focus

group expressed the importance of NAMI in providing a space where family members and loved ones

can provide mutual aid and exchange resources and knowledge about the mental health system. NAMI

also provides trainings that help family members and loved ones learn how to effectively advocate for

themselves and their loved ones in mental health treatment. NAMI also supports family members and

loved ones to conduct trainings across the County and the Bay Area on a variety of topics.

Comprehensiveness and continuity of crisis services.

Family members and loved ones of consumers in mental

health services described the continuum of crisis services

to be a weakness in the mental health system. Post crisis

services were of a particular concern of this group. Focus

group participants described follow-up from the hospital as

a critical point where consumers “fall through the cracks”

and lack the resources to achieve a fuller recovery from a

crisis episode. Family members also noted that consumers

accept treatment in the hospital but are likely to lose their

commitment to participate in treatment or take prescribed

medication upon release.

Just last year, around this time,

I went through a crisis with my

son. I was almost successful in

getting him into Contra Costa

Regional Center. We waited

seven days for transport. The

second he said, “I do not think

I’m going to kill myself,” he

was released. There was no

phone call.

-Family member



Family members and loved ones as part of the treatment

team. Focus group participants said that more can be done to

help mental health providers consider family members and

loved ones as part of the treatment team for consumers.

Particularly, family members and loved ones felt that

psychiatrists and psychologists did not regard them as a

source of valuable information or as a critical part of the

consumer’s support system.

Warm and welcoming environment throughout the mental

health system. Similarly to other focus group findings, family

members and loved ones of consumers found that the mental health system lacked a warm and

welcoming environment for both them and consumers of mental health services.

Increase the comprehensiveness and the continuity of crisis services for adult consumers. Family

members and loved ones of consumers suggested several strategies to strengthen the

comprehensiveness and continuity of crisis services. We have summarized suggestions for improvement

in the bullets below:

Increase Crisis Intervention Team (CIT) training with

local law enforcement: NAMI representatives said the

County should increase their capacity to support CIT

training with Contra Costa County law enforcement.

Develop a peer supported crisis intervention team that

responds to mental health calls alongside law

enforcement: Focus group participants requested that

the County develop a peer supported crisis

intervention team that would act as the first responder

to mental health crisis calls in partnership with law

enforcement.

Enhance post-crisis follow-up care for consumers:

Family members and loved ones of consumers

expressed that the period following a crisis event is the

most critical to ensuring their safety and health. Focus group participants suggested that the

County develop the capacity and personnel to provide intensive follow-up care for consumers in

the period immediately following a crisis. Post-crisis follow-up care includes linking consumers

to treatment, checking in with the consumers about their recovery after a crisis incident, and to

coordinate the transition back into the community from a hospital setting.

The psychiatrist changed his

[appointment] date and I

asked why did you not notify

me? Well, we only have this

one number and it didn’t

work. And the demeanor was

not welcoming, very

dismissive.

-Family member

We need triage and team..

[with] a Psychiatric Nurse

along with EMS people that

would go to answer the

5150. If we have these

other units that can go in,

this … would not create

the trauma that police

officers would create. San

Francisco has this triage/

crisis intervention team.

-Family member



Implement AB1421 (also known as “Laura’s Law”):

Family members, loved ones, and representatives of NAMI

support the implementation of AB1421 in Contra Costa

County as part of enhancing the comprehensiveness and

continuity of crisis services, specifically for those who are less

likely to engage in voluntary services. Focus group

participants expressed that AB1421 implementation would

create a safety net for consumers that need more intensive

core mental health services, such as Assisted Outpatient

Treatment (AOT), to prevent unnecessary hospitalization,

incarceration, and potential death.

Redefine ‘family of consumers’ to include loved ones or

others close to the consumer; incorporate family members

and loved ones as part of the treatment team. Focus group

participants said the County should redefine the meaning of

‘family’ to be more inclusive of those people close to a

consumer and in their immediate circle of social supports. In addition to redefining ‘family,’ focus group

participants suggested that the County should consider family

members and loved ones as part of the consumer defined

treatment team.

Increase the meaningful involvement consumers and family

members in the mental health system. Family members and

loved ones of consumers requested that the County develop

more opportunities for themselves and consumers to

participate meaningfully in the mental health system. Focus

group participants suggested that the County increase

opportunities for consumer and family member employment,

vocational training, and peer/family member led services

throughout the mental health system.

Laura’s Law- It is

paramount that we get

help for those who are not

getting help at this time.

Our families struggle with

this.

AOT, Laura’s Law, needs to

get implemented. Here we

are and we have the board

of supervisors saying we

don’t have the money. It’s

not up to us to get the

money. The needs are

there.

-Family members

Define family – families are

those people who care

about loved ones. There are

many non-traditional

families. These are the

people who do a lot of

work for the county, taking

care of our citizens. It

would behoove the county

to make use of family

members, save them

money and aggravation and

help everybody.

-Family member



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Appendices



Appendix A: Focus Group Facilitator’s Protocol

Facilitator’s Guide (talking points)

Focus Group Background (5”)

Contra Costa Mental Health (CCMH) is in the process of developing its three-year program and

expenditure plan for mental health services in accordance with Prop 63, the Mental Health Services Act

(MHSA). An essential part of this effort is the inclusion of community members in the planning process.

As such, CCMH has contracted Resource Development Associates (RDA) to help gather information from

community members such as yourselves. We will be conducting a series of focus groups in which we

will:

1. Review findings from 2013 CCMH Preliminary Assessment of Need (30”)

2. Affirm findings and discuss any other strengths and needs (10”)

3. Prioritize areas of need (5”)

4. Brainstorm ideas for meeting these needs (35”)

5. Closing remarks/Next steps (5”)

Information gathered from these focus groups in addition to the assessment of needs will provide us

with a comprehensive look of the strengths and needs of the community. This will help Contra Costa

Health Services develop its’ Mental Health Services Act (MHSA) Plan for 2014-2017.

Guidelines

Designed to be a “safe” place to talk about issues you might not otherwise feel comfortable

talking about

Participants’ names will not be linked to any comments unless we specifically ask if we can use

your comment as a quote.

Silence your cell phones – turn off the ringer and any alarms

There are no “wrong” or “right” opinions, please share your thoughts honestly

Limit side conversations so everyone can hear what is being said

Stand up; stand down

Listen before responding

Are there any other guidelines that you would like to add?

Introductions

Before we begin reviewing the assessment of needs findings, let’s get to know each other a little bit. As

you are comfortable, please share:

Your name



If you are a community member, county staff or representing a community based organization.

What you hope will come of today’s focus group

Project Background (2”)

About CCMH (refer to infographic handout)

Contra Costa County has over 1 million residents

o Estimated 60,000 residents have serious mental (adults) or serious emotional

disturbance (children)

CCMH serves about 20,000 individuals annually

o Individuals served are typically poor and struggle with housing, employment,

transportation, and medical and behavioral health care

CCMH is integrated with Alcohol and Other Drug and Homeless Programs under Behavioral

Health

CCMH works with primary care, education, social services, juvenile and criminal justice, and

community-based organizations

CCMH services include:

o Crisis intervention

o Outreach and engagement

o Therapy

o Medication and case management

o Day programs

o Housing and employment supports

About MHSA

63 passed November 2, 2004

o 1% tax on income over $1 million

o To EXPAND and TRANSFORM mental health services in California

Core Values

o Wellness, Recovery, and Resiliency

o Cultural Competence

o Client/Family-Driven Mental Health System

o Integrated Service Experience

o Community Collaboration (why we’re here today)

Contra Costa’s three-year plan should encompass these values

Current CCMH programs fall under the following MHSA components:

o Community Supports and Services

o Prevention and Early Intervention

o Workforce, Education, and Training

o Capitals, Facilities, and Technology Needs

o Innovative Projects



2013 CCMH Assessment of Needs (28”)

Procedures (refer to infographic handout)

MHSA requires analysis of community mental health needs as part of the three-year program

and expenditure plan

Assessment of needs began in September 2013 with a stratified sampling of people who are

currently providing mental health services, and those who are currently receiving services:

o Across 25 sites, all 3 county regions

o Across 4 age groups, 2 languages

o Input from over 200 service providers, consumers, and family members

Results from the surveys and focus groups focused on four main areas of mental health service: access

to services, workforce capacity, service capacity, and integration of services.

System-Wide Findings

This area of needs involves practices and procedures that are used throughout the CCMH system,

including consumers and family members’ ability to access mental health services that are currently

provided.

The CCMH system has enabled some programs to successfully provide the following services:

Proactive engagement of clients and community members

Warm & welcoming environment

Transportation provided or coordinated

Culturally & linguistically competent services

Services are located where people live

Some systematic difficulties of consumers being able to access these services include:

Lack of outreach to at-risk youth, new immigrants, and LGBTQ populations

Eligibility rules

Need for more bilingual/bicultural workers

Further, not all programs are providing all of these services, or they are not providing them at an

adequate level. As a result, there are:

Inefficient or lack of public transportation

Facilities are in need of improvements

Need to enhance the continuity of care between different systems of care (e.g. TAY to adult) or departments

More opportunities for meaningful daily activities that promote wellness and recovery



Check-In Questions:

Does this reflect your experience?

Is there anything missing that should be added to this finding?

Do you disagree with any of these findings?

CCMH Workforce Findings

This area of need involves the gaps in providers’ ability to delivery adequate services.

In some programs CCMH uses a multi-disciplinary team approach which provides consumers and family

members with:

Team-based care approach

Coordination of care

Utilizing family/peer partners or navigators

However, further growth is needed in the CCMH workforce. CCMH found the following specific

workforce needs:

More employment and career counseling for consumers/family members


Shortage of case managers and psychiatrists

Lack of admin/support staff

Better trauma-informed mental health service system to support staff and address vicarious

trauma

Check-In Questions:




Findings about Current MHSA Programs

This section reviews the current MHSA programs in Contra Costa County and looks at the

accomplishments programs have made in the provision of services, reviews areas that programs could

improve, and identifies services gaps not covered by the existing programs.



Overall- programs are working to address the needs of the community. Services that were noted to

have a successful impact are:

Provision of integrated health and behavioral health services

Coordination of care between mental health, law enforcement, education, social services, and other community or faith-based providers

Care that results in a successful outcome for the consumer

However, areas in which programs could improve include:

Provide better medication management services for clients

Determine and match the appropriate level of care based on mental health needs

Connect consumers to more affordable housing

Develop better continuity in services for before, during, and after a mental health crisis

Conduct more thorough evaluation and performance measurement of program outcomes

Better integration of peer-led services with clinic services

CCMH identified the following needs that still exist and have not been met by the current services:

Services for adults at all stages of recovery, not just for those who have a serious mental illness

“First break” program for young adults

Inpatient beds for children

Club house in West and East County

Drug treatment for youth

Flex-funds to address basic living emergencies

Check-In Questions:




Focus Group Questions (10”)

1. Are there any other areas of strengths that we have not reviewed?

2. Are there any other areas of need or barriers to receiving services that we have not reviewed?

Prioritization Activity (5”)

Thank you for reviewing the findings and providing your input about them. Now that we’ve discussed

each of these areas of need, let’s talk about which areas have the most need. We’ve re-categorized the

discussed needs into small “buckets” of needs. At this point, we’ve already reviewed and made edits to



these findings. We are now moving into talking about how CCMH can overcome these barriers and meet

these needs.

In front of you, there are three colored flags. As I read through each area of need, ask yourself, “Is this

area of need a high-priority concern for the CCMH consumers, their family members, and the service

providers?”

If you think that the area of need is a top priority, raise the red flag.

If you think that the area of need is important, but perhaps not the number one priority, raise

the blue flag.

If you think that the area of need is unimportant, or something that can be addressed at a later

date, raise the white flag.

Please remember that the focus group is designed to be a safe place to share your opinion, however, if

you so wish, you may abstain from voting.

Once the flags are counted and tallied across the “buckets” of needs, we’ll narrow the topics of

discussion to the top 3-5 buckets and think of ways we can overcome the needs.

Brainstorming Solutions (35”)

Here are the top five buckets of needs you’ve identified [list them].

Do you agree that there are areas of generally high priority?

Are you ready to move forward in discussing how we may overcome these barriers?

Great, let’s briefly talk about each of these in order and think through what needs to take place for

these issues to be resolved. If time allows, we’ll move on the remaining areas of need.

1. Refer to the current programs handout, are there ways we can modify any of these existing

programs to meet this need?

a. If so, what does that change look like?

b. What are the necessary resources to accomplish the change?

2. If not, is there an existing program that we can add to or enhance to meet this need?

a. If so, what would that addition look like?/How would it function?

b. What are the necessary resources to implement the new component?

3. If none of the existing programs can possibly accommodate the need, does CCMH need to

create a new program to meet the demand?

a. If so, who would the program serve?

b. How would the program operate?

c. How could CCMH ensure the success of the program?

d. What resources could CCMH leverage to implement a program like this?



In the event of additional time, briefly review the other areas of need and ask the group to sketch some

ideas for addressing or removing those barriers.

Thank you for your time and participation today. Your contributions are essential to this project as you

are essentially building this plan for yourselves.

___________ is here from the Office of Consumer Empowerment (OCE) to help you complete a survey

on mental health services and integration in the county. Please stay to complete the survey.

If you have further questions or ideas, please don’t hesitate to contact Roberta Chambers at

[email protected] or at 510.488.4345 x 102.



Appendix B: Informational Flyer for Focus Group Events

Contra Costa County Behavioral Health Services invites you to the:

MHSA Three-Year Program and Expenditure Plan

Community Planning Process

Provider Focus Group

Objectives:

Contra Costa County is developing its MHSA Three-Year Program &

Expenditure Plan for 2014-2017.

We are inviting you to participate in a focus group about mental health

services in Contra Costa County.

We want to hear about your priorities for mental health services and your

ideas about how to improve mental health services in the county.

Your input will be incorporated with other stakeholder feedback to produce

the new MHSA Three-Year Program & Expenditure Plan for 2014 – 2017.

Please join us!

We will be serving light snacks and refreshments! Ensure that your voice is heard

in the Community Planning Process for Contra Costa County’s MHSA programs!



Appendix C: Logistical Flyer for Focus Group Events

Contra Costa County Behavioral Health Services invites you to the:

MHSA Three-Year Program and Expenditure Plan

Community Planning Process

Provider Focus Group

Date:

Time:

Location:

Meeting Objectives: Introduce RDA and MHSA

Review Preliminary Needs Assessment findings

Collect stakeholder feedback on ideas to bridge current gaps in the

County’s mental health system

Prioritize stakeholders’ ideas to continue the transformation of the

County’s mental health system

Please join us!

We will be serving light snacks and refreshments! Ensure that your voice is heard

in the Community Planning Process for Contra Costa County’s MHSA programs!



Appendix D: Contra Costa Mental Health Assessment of Needs Handout

2013 Contra Costa County Mental Health (CCMH) Assessment of Needs

This area of needs involves practices and procedures that are used throughout the CCMH system,

including the strengths and challenges consumers and family members’ ability to access mental health

services that are currently provided.

The CCMH system has enabled some programs to successfully provide the following services:

Proactive engagement of clients and community members

Warm & welcoming environment

Transportation provided or coordinated

Culturally & linguistically competent services

Services are located where people live

Some systematic difficulties of consumers being able to access these services include:

Lack of outreach to at-risk youth, new immigrants, and LGBTQ populations

Eligibility rules

Need for more bilingual/bicultural workers

Further, not all programs are providing all of these services, or they are not providing them at an

adequate level. As a result, there are:

Inefficient or lack of public transportation

Facilities are in need of improvements

Need to enhance the continuity of care between different systems of care (e.g. TAY to adult) or departments




This area of need involves the strengths and challenges in providers’ ability to delivery adequate

services.

In some programs CCMH uses a multi-disciplinary team approach which provides

consumers and family members with:

Team-based care approach

Coordination of care

Utilizing family/peer partners or navigators

However, further growth is needed in the CCMH workforce. CCMH found the

following specific workforce needs:

More employment and career counseling for consumers/family members


Shortage of case managers and psychiatrists

Lack of administrative/support staff

Better trauma-informed mental health service system to support staff and address vicarious

trauma



This section reviews the current MHSA programs in Contra Costa County and looks at the

accomplishments programs have made in the provision of services, reviews areas where programs could

improve, and identifies services gaps not covered by the existing programs.

Overall, programs are working to address the needs of the community. Services that

were noted to have a successful impact are:

Provision of integrated health and behavioral health services

Coordination of care between mental health, law enforcement, education, social services, and other community or faith-based providers

Care that results in a successful outcome for the consumer

However, areas in which programs could improve include:

Provide better medication management services for clients

Determine and match the appropriate level of care based on mental health needs

Connect consumers to more affordable housing

Develop better continuity in services for before, during, and after a mental health crisis

Conduct more thorough evaluation and performance measurement of program outcomes

Better integration of peer-led services with clinic services

CCMH identified the following needs that still exist and have not been met by the current services:

Services for adults at all stages of recovery, not just for those who have a serious mental illness

“First break” program for young adults

Inpatient beds for children

Club house in West and East County

Drug treatment for youth

Flex-funds to address basic living emergencies



Appendix E: Contra Costa Mental Health Service Providers Handout

Mental Health Services Act (MHSA) Providers by Component

Provider Programs # Unduplicated

Clients Served FY 2012 – 2013

Counseling Options Parent Education (COPE)

Countywide services for families 575

Juvenile Assessment and Consulting Services

Supporting Families in the Juveniles Justice System

302

First Hope Early Identification/Intervention in Psychosis

106*

Office of Consumer Empowerment Stigma Reduction Not reported

*Total # unduplicated clients served from January 1, 2013 through December 31, 2013



Contra Costa Crisis Center Suicide Prevention 30,582

La Clínica de La Raza 1. Vias de Salud (Pathways to Health), also serves east county

2. Familias Fuertes (Strong Families)

1. 4,157

2. 1,062

Jewish Family and Children’s Services

Community Bridges 475

Putnam Clubhouse (aka Contra Costa Clubhouse)

Supporting Families Experiencing Mental Illness

278

Contra Costa Interfaith Housing Strengthening Vulnerable Families 238

Child Abuse Prevention Council The Nurturing Parent Program 126

Martinez Unified School District New Leaf – Youth Development 51



People Who Care Youth services 205

Center for Human Development African American Health Conductors 248





STAND! For Families Free of Violence 1,334

YMCA Building Blocks for Kids 1,015

RYSE Trauma Response & Resilience System

Health & Wellness

260

YMCA of the East Bay James Morehouse Project at El Cerrito

High School (fiscally sponsored by Youth Development)

355

The Latina Center Primo Nuestros Ninos (Our Children First) 305

Native American Health Center Native American Wellness Center 171

Lifelong Medical Care SNAP! Senior Network and Activity

Program

147



Rainbow Community Center LGBT Community Mobilization & Social Support Project

829

Older Adult Senior Peer Counseling 237

Asian Community Mental Health Services, Inc.

Asian Family Resource Center 67



Provider Programs # Unduplicated Clients Served FY 2012 – 2013

Rainbow Community Center Counseling/Case Management Services New for 13-14 Target: 125

Older Adult Mental Health Programs 1. Intensive Care Management Teams (ICMT) 2. Improving Mood Providing Access to

Collaborative Treatment (IMPACT)

1. 237 2. 138

Seneca Family of Agencies Short Term Assessment of Resources and Treatment (START)

32

SHELTER, Inc. MHSA Housing Target: 109

Recovery Innovations Wellness and Recovery Centers New for 13-14 Target: 200

Community Options for Families and Youth (COFY)

Multisystemic Therapy New for 13-14

County-Wide Assessment Team County-Wide Assessment Team New for 13-14

Lincoln Child Care Center Multi-Disciplinary Family Therapy New for 13-14

Telecare Corporation Crisis Residential Facility: Hope House New for 13-14


Central County Adult Mental Health Clinic (includes PEI and INN services)

Suicide Prevention Pilot

Women Embracing Life and Learning (WELL)

Libby Madelyn Collins Trauma Recovery Project

Direct Providers for Treatment and Case Management

Peer Support

Improving Service Delivery

3,610

Central County Children’s Mental Health Clinic

Parent Partners

Vehicles

Evidence Based Practice Clinical Specialist

810

Anka Behavioral Health, Inc. 1. Bridges to Home (BTH), also served west county

2. Behavioral Health Court

1. 185** 2. 78

Crestwood Behavioral Health, Inc. Not specified Not reported

**Bridges to Home (BTH) served a total of 185 individuals across multiple providers




East County Adult Mental Health Clinic


Peer Support


2,960

East County Children’s Mental Health Clinic

Parent Partners

Vehicles


890

Portia Bell Hume Behavioral Health and Training Center

Adult Full Service Partnership New for 13-14 Target: 60

Youth Homes, Inc. Transition Age Youth Full Service Partnership

New for 13-14 Target: 40


West County Adult Mental Health Clinic

Bridges to Home

Contra Costa Transition Age Youth


Peer Support


2,720

West County Children’s Mental Health Clinic

Parent Partners

Vehicles


1,482

Desarrollo Familiar, Inc. Familias Unidas 37

Community Mental Health for Asians Also served central county

Bridges to Home (BTH) 185**

Rubicon Programs Also served central county

Bridges to Home (BTH) 185**

Fred Finch Also served central county

Contra Costa Transition Age Youth Program

90

**Bridges to Home (BTH) served a total of 185 individuals across multiple providers



Provider Programs/Services # Unduplicated Clients Served

Community Violence Solutions Served countywide

Reluctant to Rescue 62

Rainbow Community Center Served central county

Creating a Safe Haven to Support Transgender and LGBTQQI2-S Youth Involved in Sexual Exploitation

12 in person Web visit # not

available

Other mental health service providers in Contra Costa County included:

Provider Programs/Services # Unduplicated Clients Served

Mental Health Consumer Concerns Served countywide Contract ended 12/13/13

Adult services 200

Lao Family Community Development Served west county

Family services 126



Appendix F: MHSA Values and Components Handout

Mental Health Services Act (MHSA) Values

Wellness, Recovery, and Resilience This value promotes services and systems that support consumers and family members in their efforts

to overcome mental health illness and to live productive and fulfilling lives. The MHSA works towards

strengthening and transforming mental health services and systems to reduce disparities in access,

utilization, and outcomes by age, race/ethnicity, gender, sexual orientation, language, disability,

economic status, and other affiliations.

Cultural Competence This value promotes mental health services that reflect the values, customs, and beliefs of the

population served by ensuring consumers and family members are involved in the development of

treatment plans that consider their strengths, goals, cultural background, and social beliefs.

Client and Family Driven Services This value promotes participation of consumers and family members at all phases of the design,

planning, implementation, and evaluation of mental health services.

Integrated Services This value promotes coordination among different service systems to provide a seamless experience for

consumers and family members in accessing services and supports in mental health, substance use, and

primary care.

Community Collaborations This value promotes partnerships and collaborations among service delivery systems and community‐

based organizations to support an infrastructure for seamless and competent service delivery.



Mental Health Services Act (MHSA) Components

Community Services and Supports (CSS)

The majority of Prop 63 money provides treatment for individuals with serious mental illness, using a

“whatever it takes” approach. The CSS component establishes Full Service Partnerships to provide

wraparound services to clients/consumers. The CSS component also addresses housing by leveraging

the funds in local partnerships to build and renovate housing units for people with serious mental

illness, many of whom are homeless.

Prevention and Early Intervention (PEI)

The goal of Prevention & Early Intervention programs is to prevent mental illness from becoming severe

and disabling and to improve timely access to services for people who are underserved by the mental

health system.

Innovation (INN)

Five percent of all MHSA funds support Innovation projects to test novel, creative and/or ingenious

mental health practices/approaches that show promise in improving services to mental health service

delivery with time-limited pilot programs.

Workforce Education and Training (WET)

The goal of the Workforce Education and Training (WET) component is to develop a diverse workforce.

WET funds may be used to increase the number of qualified individuals to provide mental health

services consistent with the MHSA values, and to improve the cultural and language competency of the

mental health workforce.

Capital Facilities and Technological Needs (CFTN)

The Capital Facilities and Technological Needs (CFTN) component works towards the creation of a facility

or facilities that is used for the delivery of MHSA services to mental health clients and their families or

for administrative offices. Funds may also be used to support an increase in peer-support and consumer-

run facilities, development of community-based settings, and the development of a technological

infrastructure for the mental health system to facilitate the highest quality and cost-effective services

and supports for clients and their families.



Appendix G: Focus Group Participation Summary Handout

MHSA Community Engagement Events:

Demographics of Community Engagement Participants Total Count of Participating Consumers and Family Members by Population



Transitional Age Youth (TAY) 54 29%

Latino & African American 26 14%

Adult 23 12%

LGBTQ 18 10%

Older Adult 18 10%

People Experiencing Homeless 17 9%

General Consumers and Family Members 14 7%

Latino Community 12 6%

Children & Parents 4 2%

Asian & Pacific Islander Community (API) Consumer 3 2%

Total 189 100%

Total Count of Participating Service Providers by System of Care



TAY Provider 11 31%

Adult Provider 6 17%

Children Provider 9 26%

Older Adult Provider 9 26%

Total 35 100%

Stakeholder Affiliation of Focus Group Participants

Stakeholder Affiliation Count of Participants % of Total

Community-based organization 65 39%

County government agency 25 15%

Education agency 17 10%

Provider of mental health services 14 8%

Medical or health care organization 6 4%

Social service agency 6 4%

Law Enforcement agency 1 1%

Provider of alcohol and drug services 1 1%

Other 32 19%

Total 167 100%

81 83 55

16 0

20

40

60

80

100

Consumer ServiceProvider

FamilyMember

Consumerand FamilyMember

Nu

mb

er

of

Par

tcip

ants

Count of Focus Group Participants by self-identified stakeholder group (n=235)



Count of Focus Group Participants by County Region (n=223)



West 54 24%

Central 90 40%

East 57 26%

Other 22 10%

Total 223 100%

29-59 52%

60 and older 22%

16 - 24 21%

Under 16 4%

25-29 1%

Percent of Focus Group Participants by Age (n=220)

Female 60%

Male 37%

Transgender/ Gender-

fluid 3%

Percent of Focus Group Participants by Gender (n=222)

80

59

39

22

14

4

2

0 10 20 30 40 50 60 70 80 90 100

White/Caucasian

Hispanic/Latino

African American/Black

Asian or Pacific Islander

Multi-Race

American Indian/Native Alaskan

Other

Number of Participants

Count of Focus Group Participants by Race/Ethnicity (n=220)



Appendix H: Participant Demographic Form Contra Costa MHSA Community Engagement

Participant Information

1. Do you identify yourself as a consumer or a family member of a consumer of mental health services?

☐No

☐Consumer

☐Family Member

2. Do you identify as a service provider?

☐No

☐Yes

3. What is your stakeholder affiliation?

☐County government agency

☐Community-based organization

☐Law Enforcement

☐Education agency

☐Social service agency

☐Veterans or Veterans Organizations

☐Provider of mental health services

☐Provider of alcohol and other drug services

☐Medical or health care organization

☐Other:___________________________

4. Please indicate your age range:

☐Under 16

☐16-24

☐25-59

☐60 and older

5. Please indicate your gender:

☐Female

☐Male

☐Transmale/transman

☐Transfemale/transwoman

☐Intersex

☐Genderqueer

☐Prefer not to answer

☐Other: _____________________

6. What is your race/ethnicity? (check all that

apply)

☐White/Caucasian

☐African American/Black

☐Hispanic /Latino

☐Asian or Pacific Islander

☐American Indian/Native Alaskan

☐Multi-Race

☐Other: __________________________

7. In which part of Contra Costa do you live?

☐ Antioch

☐ Brentwood

☐ Clayton

☐ Concord

☐ Danville

☐ El Cerrito

☐ Hercules

☐ Lafayette

☐Martinez

☐ Moraga

☐ Oakley

☐ Orinda

☐ Pinole

☐ Pittsburg

☐ Pleasant Hill

☐ Richmond

☐ San Pablo

☐ San Ramon

☐ Walnut Creek

☐Other:___________________________

http://en.wikipedia.org/wiki/Brooks,_California

http://en.wikipedia.org/wiki/Capay,_California

http://en.wikipedia.org/wiki/Dunnigan,_California

http://en.wikipedia.org/wiki/El_Macero,_California

http://en.wikipedia.org/wiki/Esparto,_California

http://en.wikipedia.org/wiki/Guinda,_California

http://en.wikipedia.org/wiki/Madison,_California

http://en.wikipedia.org/wiki/Monument_Hills,_California

http://en.wikipedia.org/wiki/Plainfield,_California

http://en.wikipedia.org/wiki/Rumsey,_California

http://en.wikipedia.org/wiki/Yolo,_California

http://en.wikipedia.org/wiki/Zamora,_California



Appendix I: Community Forum Presentation

contra costa county€¦ · contra costa behavioral health services consolidated report on mhsa...

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