Therapeutic Behavioral Services
(TBS)
Mental Health Board
System Planning and Fiscal Committee
January 5, 2012
Santa Clara County Mental Health Department
Emily Q vs. State DMH
•
As a result of a lawsuit (Emily Q) initiated by
advocates in 1998, state began offering TBS as
a Medi-Cal Mental Health supplemental service
•
Goal of lawsuit was to provide services to help
prevent higher levels of care or assist with
transitions to lower levels of care
•
Court has had continued oversight of TBS
implementation and there has been concern that
there has not been sufficient utilization of TBS
•
Nine-Point Settlement Plan was adopted in
November 2008 to resolve continued concerns.
One requirement of the plan is for counties to
increase TBS access and utilization.
Emily Q vs. State DMH



As of April 28, 2011, 18 county Mental Health Plans (MHP)
(includes Santa Clara County) were certified by Special
Court Master as having satisfied 4% benchmark.
On May 6, 2011, Special Court Master submitted final
report to the United States District Court recommending
the Court exit Emily Q matter and DMH take over TBS as
per post-exit requirements described in the nine point
plan.
On September 14, 2011, an order was filed by the United
States District Court, Central District of California,
adopting the Special Master’s findings and
recommendations and terminating jurisdiction by the
Honorable Judge A. Howard Matz.
Emily Q – Recommendation for
Terminating Jurisdiction

As stated in the orders:
“The Court adopts the findings and recommendations
of the Special Master in his Final Report. Defendant
Director of the Department of Health Care Services, and
the director or directors of any successor entity or
entities, shall continue to comply with the posttermination terms of the Nine Point Plan and transition
plan. Nothing in this order shall preclude subsequent
litigation regarding the obligation of counties and county
mental health plans to provide TBS. Monies remaining in
the Special Services Fund in the approximate amount of
$198,394.63 shall remain on deposit with the California
Institute for Mental Health or any successor entity, to
support TBS trainings, quality improvement activities,
data review, and continued maintenance of public TBS
data dashboards.”
What is TBS?
•
Supplemental program to an ongoing
Specialty Mental Health Service
•
Intensive, short-term, home or placementbased, 1:1 behavioral interventions
•
Trained behavioral coaches teach child or
youth and caregivers or TAY effective
coping skills, anger management skills and
mood regulation
•
Interventions are strength-based,
individualized and culturally sensitive
Who is eligible?
Insurance Eligibility
•
Medi-Cal beneficiaries up to age 21
Class Criteria Requirements
•
Is currently placed in a group home
•
“Being considered” for a group home (level 12 or above)
•
“Being considered” for psychiatric hospitalization or
has had a previous hospitalization (within last 2 years)
(Is one option, though not necessarily the only option,
that is being considered as part of a set of possible
solutions to address the child/youth’s needs)
Service Need Criteria
•
•
•
Participating in Specialty Mental Health Services
Prevent higher level of care
Transition successfully to lower level of care
Agencies Providing TBS
TBS Client Count FY10 & FY11
Agency
FY10
FY11
Bill Wilson Center
18
30
Community Solutions
4
7
EMQ (Families First)
109
113
Gardner
28
19
Hope Services
9
11
Rebekah's Children Services
55
51
Starlight
90
91
Unity Care
45
55
Total
358
377
Client Gender
Gender
FY10
FY11
Female
130
142
Male
228
235
Total
358
377
Client Ethnicity
Diagnosis Acuity
Diagnosis Acuity
FY10
FY11
1 Diagnosis
64
96
2 or more Diagnoses
285
270
9
11
358
377
Unknown
Total
Most Common Diagnoses
Diagnosis
FY10
FY11
Frequency
Adjustment Disorder With Mixed Disturbance of
Emotions and Conduct
13
Frequency
12
Anxiety Disorder NOS
9
12
Attention-Deficit/Hyperactivity Disorder NOS
9
12
Attention-Deficit/Hyperactivity Disorder,
Combined or Predominantly Hyperactive Type
32
37
Attention-Deficit/Hyperactivity Disorder,
Predominantly Inattentive Type
8
9
Depressive Disorder NOS
24
24
Disruptive Behavior Disorder NOS
29
45
Mood Disorder NOS
24
18
Oppositional Defiant Disorder
39
42
Parent-Child Relational Problem
16
11
Posttraumatic Stress Disorder
33
36
TBS Contact Information
County TBS Office: (408)793.5894 fax: (408)288.6113
QI Authorization:
Mary Harnish, MFT, QI Coordinator at (408) 793-5892
Family & Children’s Division Contact:
Sherri Terao, Ed.D. (408) 885-5776
DMH TBS Website:
www.dmh.ca.gov/Services_and_Programs/Children_
and_Youth/EPSDT.asp