Behavioral Health

Behavioral Health Services In Rural San Bernardino County

Behavioral Health Commission

David Denkers, PM II, Desert/Mountain Region Outpatient Clinic Operations Dr. Alyce Belford, Sr. PM, Criminal Justice and Substance Use Disorder and Recovery Services Dr. Tim Hougen, Interim Deputy Director, Children Services & MHSA Julie Hale, PM II, Community Crisis Services/Acting Senior PM, 24 Hour & Emergency Services

March 7, 2019

www.SBCounty.gov Rural Services provided in: Page 2

. (First District) - Victorville, Hesperia, Adelanto, Phelan, Apple Valley, (Third District) Lucerne Valley, Barstow. Population 389,960

. Mountains – (Third District) Big Bear, Crestline, Lake Arrowhead, Population 34,851

. Morongo Basin (Third District) – Morongo Valley, Joshua Tree, Yucca Valley, Twenty Nine Palms, Population 76,007

. Needles (First District) – Population 5,203

. Trona (First District) - Population 1,776

Behavioral Health www.SBCounty.gov Medi-cal Beneficiaries in San Bernardino County Page 3

July ‐ December 2018 Data Medi‐Cal beneficiaries (1) Medi‐Cal beneficiaries served (2) Penetration Rate No % No % % County wide total 793,365 100% 27,641 100% 3.5% Gender Female 431,320 54.4% 13,352 48.3% 3.1% Male 362,045 45.6% 14,253 51.6% 3.9% Unknown 0 0.0% 36 0.1% Age Group 00‐15 y 267,110 33.7% 8,427 30.5% 3.2% 16‐25 y 132,415 16.7% 5,503 19.9% 4.2% 26‐59 y 306,987 38.7% 11,509 41.6% 3.7% 60+ y 86,286 10.9% 2,202 8.0% 2.6% Missing 567 0.1% 0 0.0% 0.0% Ethnic Group African American/Black 87,025 11.0% 4,607 16.7% 5.3% Asian/Pacific Islander 35,919 4.5% 659 2.4% 1.8% Caucasian/White 142,536 18.0% 8,161 29.5% 5.7% Latino/Hispanic 444,625 56.0% 11,705 42.3% 2.6% Native American 1,891 0.2% 157 0.6% 8.3% Other 81,369 10.3% 2,352 8.5% 2.9% Residence Region Central Valley 172,723 21.8% 5,009 18.1% 2.9% Desert/Mountain 231,992 29.2% 9,616 34.8% 4.1% East Valley 204,902 25.8% 7,836 28.3% 3.8% West Valley 162,327 20.5% 4,027 14.6% 2.5% Out of Area/Unknown 21,422 2.7% 1,153 4.2% 5.4%

Notes: (1) Average number of San Bernardino County Medi‐Cal beneficiaries July ‐ December 2018 (6 months). Data obtained from MMEF files through Medi‐Cal Eligibility Data System from Department of Health Care Services. 3 Penetration rate is the number of Medi‐Cal beneficiaries served divided by the number of Medi‐Cal beneficiaries for the fiscal year. Note: Medi‐Cal beneficiaries served obtained from DBH‐R&E SIMON database as of 2/26/2019

Behavioral Health www.SBCounty.gov Desert Outpatient Clinics Page 4

Barstow Trona Clinic Clinic 40 Needles Clinic

15

Adelanto Lucerne Clinic Clinic

Joshua Tree Victorville Clinic Clinic 62

Behavioral Health www.SBCounty.gov DBH Outpatient Services* in Rural Areas Page 5

. County-run Outpatient Clinics High Desert: – 17,009 services; 2,673 clients High Desert: Barstow – 6,232 services; 1,069 clients Needles – 2,826 services; 330 clients

. Contracted Outpatient Clinics Adelanto - 870 services; 128 clients Apple Valley – 33,948 services; 3,347 clients Yucca Valley – 9,126 services; 751 clients – 3,691 services; 312 clients Trona – 46 services; 8 clients (satellite)

*All data presented is for time period July 1, 2018 – December 31, 2018

Behavioral Health www.SBCounty.gov Desert SUDS Services Page 6

Barstow Trona Clinic Clinic 40 Needles Clinic

15

Adelanto Clinic

Victorville Joshua Tree Clinic Clinic 62

Behavioral Health www.SBCounty.gov Substance Use Disorder Services in Rural Areas Page 7

. High Desert – 20,669 services; 914 clients • CHOICE Program, DBH • Barstow Counseling and Behavioral Health Center, DBH • High Desert Adolescent & Family Services Center • St. John of God Health Care Services • Needles Center for Change • Victorville Center for Change

. Morongo Basin - 3,548 services; 183 clients • Yucca Valley Center for Change • Joshua Tree Center for Change

. Mountains - 694 services; 40 clients • Big Bear Center for Change

*All data presented is for time period July 1, 2018 – December 31, 2018

Behavioral Health www.SBCounty.gov Children’s & Transitional Age Youth Rural Services (Mental Health Program) Page 8

. Children’s Services: • High Desert – 49,855 services; 3,945 clients • Morongo Basin – 4,995 services; 358 clients • Mountains – 3,813 services; 210 clients

. Transitional Age Youth (TAY) Services: • High Desert – 12,927 services; 1,282 clients • Morongo Basin – 1,657 services; 90 clients • Mountains – 1,010 services; 60 clients

*All data presented is for time period July 1, 2018 – December 31, 2018

Behavioral Health www.SBCounty.gov Desert Clubhouses Page 9

Barstow Trona

40 Needles

15 Apple Valley Adelanto

Victorville Joshua Tree

62

Behavioral Health www.SBCounty.gov MHSA Prevention & Early Intervention, Innovations & Clubhouses in Rural Areas Page 10

. Prevention and Early Intervention (PEI) Services High Desert (8 contracts) 37,966 services; 14,365 clients Morongo Basin (4 contracts) 21,376 services; 3,888 clients Mountains (8 contracts) 7,705 services; 2,730 clients

. Innovations Services RBEST - 350 encounters; 66 clients

. Clubhouses in Barstow, Victorville, Lucerne, Yucca Valley Outreach and Engagement: 10,490 services System Development: 3,769 clients

*All data presented is for time period July 1, 2018 – December 31, 2018

Behavioral Health www.SBCounty.gov Community Crisis, Diversion, & Crisis Stabilization Continuum of Care Services Page 11

. Community Crisis Response Teams (CCRT)

. Crisis Walk In Centers (CWIC)

. Triage Engagement and Support Teams (TEST)

. Crisis Residential Treatment Centers (CRT)

Behavioral Health www.SBCounty.gov Desert Community Crisis, Diversion, & Crisis Stabilization Continuum of Care Services Page 12

Desert Crisis Services

Barstow Trona Clinic TES Clinic T TES Needles T 40 Clinic

15 Apple TES Valley T

Adelanto TES T Clinic TES CRT T TES TES CRT JoshuaT Tree T Victorville P Clinic CCR Clinic T CWI P C

TES CCR 62 CWI T T Hesperia C

Behavioral Health www.SBCounty.gov Community Crisis Response Team High Desert Morongo Basin Page 13

High Desert Morongo Basin . 1,267 services for 263 clients . Crisis mobile services in Morongo Basin . Services available 7:00 a.m. – 10:00 p.m. were suspended mid-2017 due to staffing 365 days a year to: shortages . January 2019: Community Crisis Response • Assist with Sheriff transports from Team was reinstated in the Morongo Basin Needles and Trona region • Provides field response for crisis . Services currently available 8:30 a.m. – intervention in Victorville, Hesperia, 4:30 p.m. Monday-Friday Adelanto, Apple Valley, Barstow, Phelan and Lucerne Valley to: . Law Enforcement Agencies • Provides field response for crisis intervention in the Morongo Basin region . Schools to: . Personal Homes and Group Homes . Law Enforcement Agencies . Board and Care Facilities . Schools . Medical and Behavioral Health Outpatient Clinics . Personal Homes and Group Homes . Families and Self Referral . Board and Care Facilities . Medical and Behavioral Health *All data presented is for time period July 1, 2018 – December Outpatient clinics 31, 2018 . Families and Self Referral

Behavioral Health www.SBCounty.gov Crisis Walk In Centers - Desert Region Page 14

. Crisis Walk In Center (CWIC) in Victorville and Joshua Tree: • Provides urgent mental health services 24/7 crisis stabilization and crisis intervention services • Serves the High Desert (1,361 services for 978 clients) and Morongo region (650 services for 415 clients) • Serves Voluntary Walk In Consumers • Engages support system in problem solving • Provides resource for Law Enforcement • Provides medication evaluations • Alternative to Hospitalization or Incarceration • Partners with CCRT, Law Enforcement and Hospital Emergency Departments

*All data presented is for time period July 1, 2018 – December 31, 2018

Behavioral Health www.SBCounty.gov Triage, Engagement, and Support Teams (TEST)Page 15

Rural Areas include the High Rural Co-Location Sites: Desert, Morongo Basin, and High Desert . Apple Valley Sheriff’s Office Mountain Regions: . Barstow Police Department . Staff follow up on all Crisis . Barstow Sheriff’s Office Intervention Training (CIT) . Hesperia Sheriff’s Office referrals from Sheriff’s Offices . St. Mary Medical Center throughout the rural areas . Victorville Sheriff’s Office . Staff include Social Workers, . Desert Valley Hospital (pending) . Victor Valley Community College Alcohol and Drug Counselors, (pending) Mental Health Specialists, or Mountain Region Clinical Therapists . Big Bear Sheriff’s Office . Staff coordinate with . Twin Peaks Sheriff’s Office CCRT/CWIC/CSU/CRT Morongo Basin . Joshua Tree Probation Department

Behavioral Health www.SBCounty.gov Triage, Engagement, and Support Teams (TEST) Page 16

. The High Desert had 611 encounters with 256 unique consumers

. The Morongo Basin had 133 encounters with 46 unique consumers

. The Mountains had 310 encounters with 110 unique consumers

*All data presented is for time period July 1, 2018 – December 31, 2018

Behavioral Health www.SBCounty.gov Triage, Engagement, and Support Teams (TEST) Updated and Future Expansions Page 17

In 2017/2018 TEST Expanded In 2019 TEST plans to expand service in rural areas by: in rural areas by adding Social . Added a Social Worker II to Worker IIs to the following new new co-location site: co-location sites: • Barstow Police Department • Victor Valley College • Desert Valley Hospital . Added Social Worker IIs to • Joshua Tree Sheriff Department new co-location sites: • St. Mary Medical Center • Apple Valley Sheriff Office

Behavioral Health www.SBCounty.gov Crisis Residential Treatment (CRT) Page 18

. SB82 Investment in Mental Health Wellness of 2013 • Awarded from the California Health Facilities Financing Authority (CHFFA) . Desert Hill Center, located in Victorville • 16 beds, served 45 clients, for a total of 1,770 bed days . Morongo Oasis Center, located in Joshua Tree • 16 beds, served 39 Clients, for a total of 1,256 bed days . Home like treatment environment . Contracted program . Provide Crisis Intervention and Crisis Stabilization services for up to 90 days . Individual, Group and Family Therapy . Will provide linkage back to lower level of care and outpatient services upon discharge

*All data presented is for time period July 1, 2018 – December 31, 2018

Behavioral Health www.SBCounty.gov Mountain Services: All Programs Page 19

Contract Childrenʹs Crisis‐TEST SUDS Clinic Services

Behavioral Health www.SBCounty.gov Strategies in Place to Increase Services in Rural Areas Page 20

. TEST Expansion in 2019

. Increase clinical coverage in Morongo via the CCRT Program

. Added a General Mental Health Clinic in Adelanto

. Assist with IEHP Psychiatry shortage in High Desert

. FSP Expansion in High Desert

Behavioral Health www.SBCounty.gov Questions Page 21

Behavioral Health www.SBCounty.gov