Ventura
County
Behavioral
Health
Fiscal Year 2013-2014
Annual
Summary
Introduction
The purpose of the Annual Summary for Fiscal Year 2013-2014 (FY13-14) is to provide a broad overview of
organizational activities and services delivered by the Ventura County Behavioral Health (VCBH) mental health
programs. This data represents all VCBH outpatient and contractor sites. The data is obtained from a wide
range of sources, including demographic and billed services entered in the VCBH management information
system, clinical outcome and satisfaction measures, surveys, and referral tracking. In addition, in order to
provide a context to VCBH information, data is employed from the U.S. Census, the California Department of
Health Care Services, and the National Institute of Mental Health. The data and programmatic information
contained in this report can be selectively used for reports and presentations requested by VCBH managers.
Table of Contents
Ventura County Demographics …………………………………………………………………………………………………………………………………2
VCBH Clinical Data ……………………………………………………………………………………………………………………………………………………4
VCBH Services Data ........................................................................................................................................................5
Quality Indicators
Efficiency ......................................................................................................................................................................6
Client Centered………………………………………………………………………………………………………………………………………………….…..7
Sustainability………………………………………………………………………………………………………………………………………………………….8
Access…………………………………………………………………………………………………………………………………………………………………….9
Ventura County Behavioral Health
VCBH Consumer Characteristics ……………………………………………………………………………………………………………………………….3
Efficacy………………………………………………………………………………………………………………………………………………………………...10
Safety……………………………………………………………………………………………………………………………………………………………………11
Timely Response…………………………………………………………………………………………………………………………………………………..12
VCBH Initiatives & Changes……………….…………………………………………………………………………………………………………………...13
Consumer Comments………………………………………………………………………………………………………………………………………….17
1
Fiscal Year 2013-2014
Ventura County Demographics
38% Use
language
other than
English in
home
25%
under 18
13% over
65
Populatio
n
Ventura County Behavioral Health
842,967
42% Latino
47% White
8% Asian and
Pacific Islander
2% African
American
10.3% below
poverty
1,936
estimated
homeless in a
day
Other Facts






2
Median
Household
income
$76,483

The data source for the above demographics is the U.S. Census State and County Quickfacts, homeless
data is from the Ventura County 2013 Homeless Count, and county population is from California
Department of Finance 2013.
Ventura is the twelfth most populous California County and is thus classified as a “large” county.
The Median Household Income (MHI) is $76,483, with the lowest MHI of $54,168 in the City of Santa
Paula and the highest of $115,018 in the City of Westlake Village. In general, East Ventura County is
more affluent, particularly along the highway 101 corridor.
o Housing costs are a challenge for many families in Ventura County with the mean housing
price at $493,500 as of November 2014 (www.zillow.com).
o Oxnard and Ventura account for approximately two-thirds of the homeless population in
Ventura County.
o 30% of homeless individuals were released from a corrections facility in the last year.
The largest industries are education, health, and social services (18%).
Latinos are by far the largest minority group in Ventura County and are overwhelmingly of Mexican
origin. In contrast, the small percentage of Asians represents an extremely diverse group of
ethnicities, including individuals of Middle Eastern, South East Asian, and Pacific Islander decent.
The largest concentration of Medi-Cal eligibles is in the Oxnard Plains (46%) followed in distant second
by Ventura (12%).
Ventura County is ranked 15th out of 58 counties with regard to health, as measured by mortality,
morbidity, health behaviors (i.e., obesity, smoking, etc.), clinical care, social and economic factors, and
physical environment (www.countyhealthrankings.org).
Race
Demographics
Age
Court Status
Location
•60% Caucasian
•30% Other
•4% African
American
•6% Multiple
Race
•46% Latino
Ethnicity
•12% Spanish
Language
•50% Male
•6% 0 to 5
•35% 6 to 18
•9% 19 to 24
•48% 25 to 64
•4% 65+
•4.7% Foster
Youth
•3.5% Juvenile
Offender
•1% Involuntary
Commitment
•44% Oxnard
Plains
•20% Ventura
•11% Simi Valley
•10% Conejo
Valley
•8% Santa Clara
Valley
Other Facts






Latinos represent the only county minority threshold population as they constitute 69% of the MediCal population. Being a threshold population means that the population constitutes more than 5% of
the local Medi-Cal population and thus requires services tailored to their needs. In addition, Spanish is
the only threshold language (other than English), which requires that materials and paperwork be
produced in this language for clients. The predominance of Latino and Spanish Speaking consumers is
therefore consistent with this focus.
The concept of race is distinct from ethnicity. Race is defined as groups based on common biological
traits deemed socially significant, while ethnicity refers to grouping based on cultural practices and
perspectives.
Adults constitute the largest segment of consumers served, particularly the 25 to 64 age range. The
smallest age groups served are ages 0 to 5 and older adults (65+).
The significant percentage of the foster youth served is via the VCBH Child Welfare Subsystem
collaboration with the Human Services Agency.
Similarly, VCBH provides extensive on site clinical services in the county Juvenile Justice Facility, which
accounts for the significant percentage of those youth served.
The majority of consumers served reside in the Oxnard plains (i.e., Oxnard, Camarillo, Port Hueneme),
where the preponderance of Medi-Cal recipients live, followed distantly second by the City of Ventura.
Ventura County Behavioral Health
VCBH Consumer Characteristics
3
Fiscal Year 2013-2014
VCBH Clinical Data

Diagnosis by Division
100%
80%

60%
40%
20%

Ventura County Behavioral Health
0%
Y&F


Adults
VCBH diagnostic data indicates the majority of
youth consumers have Mood Disorder,
Disruptive Behavior, Adjustment Disorders
(which often include mood and disruptive
symptoms).
The most frequently endorsed presenting
problems on parent-completed outcome
measures are all symptoms of Mood,
Disruptive Behavior, and Adjustment
Disorders.
VCBH Youth data is consistent with National
Institute of Mental Health (NIMH) studies
which demonstrate the lifetime prevalence of
a “severe mental disorder” for 13 to 18 year
olds is 21.4%, with the most frequently
occurring being Disruptive Behavior and Mood
Disorders.
For adults in the general population, the prevalence rate of a “Serious Mental Illness” is approximately
4.5%. “Serious Mental Illness” would constitute a chronic and severely impairing psychotic or mood
disorder.
VCBH adult self report data and diagnostic is again consistent with this NIHM study, as Mood and
Psychotic Disorders, which constitute serious mental illnesses, are overwhelmingly dominant with the
consumers we serve.
Top Three Reported Clinical Symptoms at Intake:
Preschool Parent Form
4
Parent Form
Adults Self Report Form
Restless, constantly active
Arguing with others
Racing thoughts
Easily upset
Refusing to do what is asked
Feeling sad or depressed
Disobeys adults
Can't seem to sit still
Impaired concentration
VCBH Services Data
FY10-11
FY11-12
FY12-13
FY13-14
• 11,352 Clients
• 378,383 Contacts
• 19,339,593 Units
• 13,932 Clients
• 427,115 Contacts
• 21,613,562Units
• 14,881 Clients
• 439,814
Contacts
• 22,060,780 Units
• 14,997 Clients
• 451,166 Contacts
• 23,119,459 Units

50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%

Adults
Y&F
Service Location
Home
4%
School
8%
Other
9%

Phone
8%
Field
8%
Fiscal Year 2013-2014
Office
63%
This fiscal year has seen the continued
increases in number of clients served,
number of client contacts, and units of
services delivered.
Of the approximately 23 million units of
service provided, there is significant variance
across divisions of what these services entail.
This is exemplified with Youth & Family data
indicating the predominance of collateral
services that involve service delivery with
family members, and Therapeutic Behavioral
Services (TBS), which are intensive
behavioral services for youth up to age 21.
In addition, since the Adult Division targets
the seriously mentally ill, there is a greater
emphasis on medication support and
rehabilitation. The Adult Division also
provides essential services that are
unbillable, such as client transportation to
appointments.
With regard to service location, most
services take place within the service
provider’s office, while 20% of services take
place in the field, home or school.
Ventura County Behavioral Health
Outpatient Services Provided
5
Quality: Efficiency
Making the best use of limited resources and reducing waste



Ventura County Behavioral Health
Median Units of Service Per Consumer
This data reflects the median units of service a
client receives in a year. The median is used as
a measure of central tendency due to the
skewed nature of data, as a small number of
clients receive a large percentage of services.
For outpatient services, a unit is equal to a
minute of service. For residential and
inpatient services, a unit is equal to a 24 hour
day. For day treatment, a unit is equal to a 4
or 6 hour day.
Adult consumers tend to receive fewer units of
service since interventions are focused on
medication management, while youth services
focus on behavioral and family interventions.
There was a two-year trend of decline for
Youth and Family services, but that changed
with the latest figures, reflecting an increase
for both Adults and Youth.

Median Contacts Per Consumer
1200
1100
1000
900
800
700
600
500
400
300
200
100
0
10-11
Adult

20
18

16
14
12

10
8
6
4
2
0
10-11
Adult
6
11-12
Youth
12-13
13-14
VCBH Total
11-12
Youth
12-13
13-14
VCBH Total
This data reflects, on average, how many times a
client receives a service in a year. The median is
again used as a measure of central tendency due
to the skewed nature of the data.
Similar to the Units of Service data, there has
been an increase in the contacts for Youth and
Family consumers that match the number for
Adults.
The trend for last year was 12 contacts for both
Youth and Adults per year.
Quality: Consumer Centered
100%
% of Consumers Reporting High
Service Satisfaction

90%
80%

70%
60%

50%
40%
30%
20%

10%
10-11
Adult



11-12
Youth
12-13
13-14
All consumers, staff, and/or caretakers respond to the
Ventura County Outcome System (VCOS) at intake,
annual, and discharge. Satisfaction and quality of care
questions from the VCOS are analyzed from consumers
at annual review and discharge.
This graph summarizes the percentage of highly
satisfied consumers, i.e., those consumers providing a
rating of eight or greater on a ten point scale.
The data generally suggests that consumers are
maintaining a high level of satisfaction with VCBH
services over the years. Parents report the greatest
level of satisfaction and youth have had an increase in
FY 13-14.
Specific comments regarding satisfaction with services
can be seen in the consumer comments section of this
report.
Parent
This question from the VCOS satisfaction section
assesses consumers’ views about the fit of
services to their or their children’s needs at
annual review and discharge.
This data continues to suggest that the
overwhelming majority of consumers and/or
their parents feel that VCBH services are a good
fit for their needs– a direct measure of consumer
centeredness.
High levels of service satisfaction across adults,
youth, and parents, adds further support to the
consistency of positive service satisfaction.
100%
% of Consumers Reporting Services are
a Good "Fit"
90%
Ventura County Behavioral Health
Providing care that is respectful of and responsive to individual consumer preferences, needs, and
values, and ensuring that patient values guide all clinical decisions.
80%
70%
60%
50%
40%
30%
20%
10%
10-11
Adult
11-12
Youth
12-13
13-14
Parent
7
Fiscal Year 2013-2014
Quality: Sustainability
The ability to economically continue the provision of services
Average Productivity

100%
90%

80%

70%
60%
Productivity is the amount of client-centered
activity clinical staff engaged in during the total
course of their work time.
A data point represents the average
productivity across a 12 month period.
The Adult Division continued to increase
productivity, while the Youth & Family Division
had a slight decrease this last fiscal year.
50%
40%
30%
Ventura County Behavioral Health
20%
10%
10-11
Adult




11-12
12-13
Youth
13-14
Goal
VCBH is the primary provider for mental health
services for Medi-Cal recipients who meet
medical necessity, which is the combination of
having a covered diagnosis and the level of
functional impairment that puts the individual
at risk for hospitalization and/or placement.
VCBH also provides services for individuals
without insurance and with private insurance.
This data indicates the Medi-Cal status of all
VCBH consumers at the end of the fiscal year.
This past year, there has been a resurgence of
Medi-Cal consumers, which may be
attributable to a combination of the efforts of
VCBH to increase Medi-Cal consumers and the
increase of Medi-Cal eligibility in the
population.
% of Consumers with Medi-Cal
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
10-11
Adult
8
11-12
Youth
12-13
13-14
VCBH Total
Quality: Access
The degree to which individuals are able to obtain needed services

Medi-Cal Penetration Rate
VCBH Total

CY07 CY08 CY09 CY10 CY11 CY12 CY13
4.9% 5.2% 5.1% 4.9% 4.8% 4.6% 5.0%
VCBH Latino 2.4% 2.8% 3.0% 3.4% 3.3% 2.9% 3.5%
State Total
6.2% 6.2% 6.0% 5.7% 5.7% 5.9% 5.6%
State Latino 3.3% 3.4% 3.5% 3.5% 3.7% 3.9% 3.9%



This indicator is the number of VCBH
Medi-Cal consumers being retained for 5
or more services divided by the total
number of VCBH Medi-Cal recipients. This
is a DHCS required metric.
While the penetration rate represents
Medi-Cal consumers entering services, the
retention rate represents those
consumers who are engaged in services.
VCBH has surpassed the state average 7
out of 8 years.
Medi-Cal Retention Rate for 5+ Services
100%
Ventura County Behavioral Health
10.0%
9.0%
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
Medi-Cal penetration rate is the total
number of VCBH Medi-Cal consumers
divided by the total number of Medi-Cal
recipients in Ventura County.
While the overall penetration for VCBH
remains relatively constant at 5%, it has
steadily increased for Latino clients.
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
CY07 CY08 CY09 CY10 CY11 CY12 CY13
VCBH Total 78% 76% 78% 74% 77% 70% 78%
State Total 75% 74% 75% 72% 73% 74% 74%
9
Fiscal Year 2013-2014
Quality: Efficacy
The degree to which services yield maximum benefits or results
% of Consumers with Improved Functioning

100%
90%

80%
70%
60%
50%

40%
Ventura County Behavioral Health
30%
20%
10%
10-11



11-12
12-13
Adult
Youth
13-14
Consumer functioning was assessed using the
Clinical Global Impression (CGI) Improvement
Scale. The CGI is one of the most commonly
used measures in treatment studies of
consumers with mental disorders.
This data represents those consumers with
improved functioning at the end of treatment
for youth and at annual for adults, as there are
differential discharge patterns for the two
populations.
In the last year the percentage with improved
functioning has been maintained for youth
while showing a slight decline for adults. Note:
Adult data should only be compared to youth
for descriptive purposes. Because of the
seriousness and chronic nature of adult mental
illness, more significant challenges in functional
improvement are expected.
The symptoms of consumers prescribed
medication were assessed using the Clinical
100%
Global Impression Efficacy Index.
90%
In the Adult Division, the majority of consumers
are prescribed medication, while in the Youth & 80%
Family Division, it is the minority of consumers.
70%
This data continues to suggest a high level of
symptom remediation across both divisions.
60%
Furthermore, in contrast to the data on
50%
functioning, similar levels of improvement are
seen across both divisions.
40%
% of Consumers with Symptom Remediation
After Receiving Services
30%
20%
10
10%
10-11
11-12
12-13
Adults
Youth
13-14
Quality: Safety
Avoiding injuries to individuals from the care that is intended to help them



% of Compliant Clozapine Labs
The medication clozapine is an atypical
antipsychotic medication that is used to treat
symptoms of schizophrenia and other psychotic
disorders.
Clozapine can sometimes cause agranulocytosis,
a severe reduction in white blood cell count that
can result in a fatal inability to fight infections.
Therefore, regular laboratory work is required
for the early identification of this condition.
Data is obtained from an annual audit of 25% of
consumers being prescribed Clozapine.
“Routines” represents regularly occurring labs.
“Repeats” represent compliance with labs that
are required for significant drops in white blood
cell count that occur between two time periods
or an absolute value that falls below a certain
range.
Data suggests that compliance is perfect to near
perfect for “Routine” labs. “Repeat” labs occur
less frequently and there has been a drop in
compliance since FY10/11.
% of Consumers Reporting Being
Informed about Side Effects/Emergency
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
10-11
Routines

100%

90%
80%
70%

60%
50%
40%
11-12
12-13
13-14
Repeats
Ventura County Behavioral Health

This question from the satisfaction survey
assesses whether consumers prescribed
medication were told what to do in case of side
effects or an emergency.
Consumer reports are contingent upon a
number of factors, including education by VCBH
and their own memory for instructions.
In 13-14 Adult and Parent reports maintain their
level of satisfaction in this area, staying within
the 85 – 90% range. Youth services saw a drop
in this area in fiscal year 13-14.
30%
20%
11
10%
10-11
Adult
Fiscal Year 2013-2014
11-12
12-13
13-14
Youth
Parent
Quality: Timely Response
Reducing delays for those who need care

Ventura County Behavioral Health

The Screening, Triage, Assessment, & Response
Team (STAR) logs intake appointments offered 100%
90%
to consumers who contact STAR for services.
This tracking is done according to three levels of 80%
need, each with different deadlines: Urgent (3
70%
working days), Expedited (14 calendar days),
60%
and Routine (28 calendar days).
50%
With regard to expedited and routine cases, the 40%
STAR program has continued to demonstrate
30%
substantial gains in meeting established
20%
deadlines. This is the result of the STAR team
10%
making focused performance improvement
efforts on these indicators. These are the
highest marks to date for this indicator.
100%
% of Consumers Reporting They
Received Appointments When Needed
90%

80%
70%
60%
50%
40%
30%
20%
10%
10-11
Adult
12

11-12
Youth
12-13
13-14
Parent
% of Consumers Offered Appointments
Within Established Deadlines
10-11
Urgent
11-12
12-13
13-14
Expedited
Routine
This indicator from the satisfaction section of
the VCOS represents the percentage of
consumers who received an appointment as
soon as they needed one.
Consumers report a high level of satisfaction
with the timeliness in which they are provided
appointments. This high level of satisfaction
continues to be present across adult, youth, and
parents in the last year.
VCBH Initiatives and Significant Changes
Restorative Justice
Solutions Program (MHSA Funded): In FY 13-14, VCBH initiated enhancements in the Solutions Court
program, which is being implemented by Interface. One major enhancement was the focus shift to cooccurring treatment, which involved implementation and adaptation of the evidence-based drug treatment
program, Adolescent Community Reinforcement Approach (ACRA). The training of clinicians in co-occurring
approaches was assisted by the 9 month addition of an ADP Alcohol Drug Treatment Specialist to the Solutions
program team, who provided the staff with drug treatment training and consultation. Currently, all Interface
Solutions staff are training and implementing a co-occurring treatment approach.
Specialized Care and Access
Reducing Latino Disparities: In November/December 2013, VCBH consulted with Dr. Sergio Aguilar-Gaxiola,
MD, PhD (Director for Reducing Disparities) from UC Davis. Dr. Aguilar-Gaxiola participated in the California
Reducing Disparities Project authorized under the Mental Health Services Act. As a result of this consultation,
VCBH reformatted its various programs to mirror the Six Core Strategies recommended in the “CommunityDefined Solutions for Reducing Mental Health Disparities” report: 1) Academic and School-Based Mental
Health Programs; 2) Community-Based Organizations and Co-Locating Resources, 3) Community and Social
Media, 4) Workforce Development, 5) Culturally and Linguistically Appropriate Treatment, and 6) Community
Capacity-Building and Outreach and Engagement.
Ventura County Behavioral Health
Juvenile Justice: Juvenile Justice VCBH has continued their work in bringing restorative justice (RJ) practices to
Ventura County through their on-going leadership in the Ventura County Restorative Justice Collaborative
(https://www.facebook.com/pages/Ventura-County-Restorative-Justice-Collaborative/836923066320626).
Juvenile Justice VCBH has collaborated with Ventura County Office of Education, who provided RJ training for
school staff. Juvenile Justice VCBH was instrumental in working with Ventura County Medical Center to host a
3 day RJ training focused on the criminal justice system, which was attended by participants from VCBH,
VCMC, Probation, community-based organizations, crime victim groups, etc. Juvenile Justice VCBH has been
implementing practices based on RJ principles, including RJ healing circles with Juvenile Facility detainees.
Through the establishment of a community driven stakeholder process, two initiatives were launched to
examine, develop and implement strategies to increase the number of Latinos served by VCBH in South Oxnard
and the Santa Paula regions. Highlights of some of the changes over the last year:





Implementation of the Rapid Integrated Support and Engagement (RISE) team deployed to engage
the underserved populations in these regions.
Expansion of the Adults and Youth & Family Clinics into South Oxnard at a location with greater
public transit, and co-located with primary care and public health services.
Mixteco Indigena Community Organizing Project (MICOP) began programming at the Centerpoint
Adult Wellness & Recovery Center.
Expansion of evening hours in all VCBH Clinics.
Stigma Reduction Campaigns in English and Spanish, designed with community input, and
implemented in both regions
Fiscal Year 2013-2014
13


Implemention of telepsychiatry in Oxnard starting in 2015
Development of treatment plans in Spanish
VCBH has made significant progress since 2006 but acknowledges that there is still much more work to do (see
following graphs), therefore, initiatives to continue reducing disparities in mental health care for Latinos are
long-term, and continually evolving and improving over time. For example, currently we are developing a
Request for Proposal for expanding and enhancing promotoras; we are working to understand the various
data and baselines to ensure improved ability to accurately measure progress, and the Office of Health Equity
manager is researching how VCBH can assess organizational cultural competence through objective criteria.
14.00
12.00
Medi-Cal Penetration Rate Ratios
White : Hispanic
2006 = 5.6:1 Ventura
2013 = 2.9:1 Ventura
2014 not available at this time
10.00
Ventura County Behavioral Health
8.00
6.00
5.6
4.1
4.00
3.7
3.4
3.2
Ventura - Hispanic
3.1
2.9
2.00
Ventura - White
Ratio - White : Hispanic
0.00
2006 2007 2008 2009 2010 2011 2012 2013
Penetration Rate
4
14
5.0
3.5
Hispanic Medi-Cal Penetration Rates 2006 – 2013
*Ventura County vs. Large County Average
3.67
3.33
3.46
3
2.5
2
2.12
Ventura - Hispanic
1.5
1
Large County - Hispanic
0.5
0
2006
2007
2008
2009
2010
2011
Calendar Year
2012
2013
Linear (Ventura Hispanic)
Older Adult Full Service Partnership: The Older Adult Full Service Partnership provides services to consumers
60 years of age and older, who, due to a serious mental illness (SMI), have a reduction in personal or
community functioning and are best served in the public specialty mental health system. Due to multiple
mental health issues and physical challenges, this population is often unable to access appropriate outpatient
mental health services through community-based clinics. Frequently, these individuals with persistent mental
illness are homebound, homeless and or in crisis. The Older Adults Program provides comprehensive,
community and home-based “whatever it takes” services which focus on the whole client, in an atmosphere of
wellness and recovery. Peer staff or recovery coaches assist in engaging new and current consumers and
provide support services and advocacy. The entire team has been trained in Health Navigation, working with
clients to teach them advocacy and communication skills when interfacing with the healthcare providers in a
medical setting. To date, 79% of enrolled clients have been engaged in Health Navigation. During the past two
years the Older Adults Program has developed an enriched program that provides socialization and
rehabilitation, as well as wellness and recovery groups, which engage clients in a once a week intensive
socialization program. Program enrichment has been observed to both improve the lives of clients, as well as
provide fulfillment for participating staff. Rehabilitation groups are facilitated in two of the Board and Cares
where many older adult clients reside. Additionally, the program organizes socialization events for holidays
throughout the year. The themed events are a forum for social interaction and rehabilitation, addressing
social isolation that elderly, seriously mentally ill and physically impaired population faces.
Ventura County Behavioral Health
Expansion of Child Welfare Subsystem (CWS) – Katie A. Implementation: Ventura County’s collaborative
infrastructure to provide expanded and integrated services to foster children was established with shared
leadership and accountability from both the Health and Human Service Agency and the Behavioral Health
Department (BHD). Collaborative workgroups during this past year met regularly and successfully rolled out
various elements of program implementation. Services were established in a manner that is family centered
and consistent with the Core Practice Model and the State mandate. Specific examples of collaboration and
coordination of services include: the implementation of the Mental Health Screening Tool (MHST), completed
by Child and Family Services (CFS) and reviewed by BHD for all children newly entering the CFS system;
establishment of an assessment team integrated into BHD to triage, assess, and provide mental health
treatment; expansion of contract providers developing a continuum of services to meet the specialized
developmental, cultural, and trauma-informed treatment needs of the foster care child and family; universal
screening and identification of children receiving mental health services using a Katie A. Eligibility Subclass
Screening Tool, to ensure children get the appropriate level of services as per the mandate; weekly “Services
Staffing” with CFS, CWS, and multiple community-based providers in attendance to provide a high level of
coordination of mental health services and efficiency in identification of family and children in need.
Retention and Engagement
Rapid Integrated Support and Engagement (RISE): Ventura County Behavioral Health has launched a new
program called Rapid Integrated Support & Engagement (RISE), primarily funded by the Investment in Mental
Health Wellness Act of 2013. The new team will provide multiple services including extensive countywide
outreach to clients who are at risk of a mental health crisis, currently experiencing a mental health crisis, or at
risk of re-experiencing a mental health crisis. The main goal is to successfully link clients to the appropriate
level of mental health care they require by providing robust transitional case management and clinical services
in field settings. Prime target groups are those who traditionally “fall through the cracks” without special
intervention, i.e. homeless, post- psychiatric inpatient hospital clients, etc. and other underserved
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Ventura County Behavioral Health
populations. The RISE team will also be available to respond to sub-acute crises in the community that do not
require the deployment of the existing Adult Mobile Crisis Team. The RISE team will be able to conduct short
notice psychosocial assessments in the field to expedite treatment. Importantly, RISE staff will be strategically
located at Hillmont Psychiatric Center (HPC) 7 days a week to provide effective coordination of follow up care
for enrolled and unenrolled clients that come into contact with HPC. Furthermore, this new grant allows for
the expansion of the current Adult Mobile Crisis Team which will mean even faster response times, increased
service in the East County, and more in-person responses to non 5150 calls. The RISE team is working closely
with law enforcement and other community partners to ensure effective and efficient service delivery in
Ventura County.
Transitional Age Youth (TAY): The Transitions Program serves Transitional Age Youth (TAY), ages 18-25 with
serious mental illness by addressing their full spectrum of needs. Transitions focuses upon a client driven
model, which integrates wellness and recovery into its array of services, including psychiatric treatment,
individual therapy, intensive case management services, group treatment and rehabilitation services. While
ensuring capacity to provide services within the clinic setting, the Transitions Program ensures that clinicians
and case managers will also provide field based services within homes, community and the TAY Wellness and
Recovery Center. Peer staff or “Recovery Coaches,” support consumers in the achievement of their wellness
and recovery goals. The program serves both the east and west regions of Ventura County and has been
effective in expanding access to services to traditionally un-served and underserved TAY in these areas. TAY
services are unique in that staff often find creative and unique ways to engage clients that otherwise would
not engage in traditional mental health services. Programming has expanded to include Evidenced Based
Practices (EBPs) such as Integrated Dual Diagnosis Treatment, Seeking Safety and Depression Treatment
Quality Improvement to address symptoms of depression, dual diagnosis, and trauma.
Prevention and Early Intervention: Through collaboration with consumers, family members, public agencies,
private providers and communities, ensure access to the highest quality mental health and alcohol and drug
prevention, early intervention and treatment services, as an integrated component of the Ventura County Health
Care System. Imagine a large, rushing river. People along the shore are working frantically trying to rescue those
who have fallen into the river. Then one person begins to run upstream. One of the other rescuers shouts, “Where
are you going? There are so many people who need help here!”
“I’m going upstream to find out why people are falling into the river – and try to keep them from falling in.”
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Universal prevention initiatives aim to prevent problems before they happen and keep people from falling into the
river. Universal prevention reduces the number of people who need treatment and frees up more resources to aid
people with serious and persistent mental health and substance abuse problems. Early Intervention can change the
trajectory of an illness and the direction of a life. The Early Detection and Intervention for the Prevention of
Psychosis (EDIPP) is an early intervention program that can delay and even prevent the onset of an acute psychotic
disorder. As of now, in its 100% of fully participating enrolled youth have not had a conversion to a psychotic
disorder. VCBH aims to see prevention and early intervention strategies become part of the norm of mental health
and alcohol and drug services.
Other Initiatives and Changes
Data Collection and Reporting: Quality Improvement continues to make new reports available in Avatar in
response to need. During this period, standard reports were adapted to be grouped by division, which is an
addition to the already available program-grouped reports. This allows managers to easily view analyses on
services, consumer and service volume, consumer demographics, and diagnosis on a larger scale. Additionally,
summaries of outcome measures are now being delivered through Avatar, with a report for each version of the
Adult, Youth, and Preschool Ventura County Outcome System (VCOS) form. This includes self-reports,
caregiver reports, and measures taken by clinic staff on client hopefulness, functioning, stability of housing,
and service satisfaction.
Another addition to reporting is the Dashboard Report, which was created to overview the status of Behavioral
Health operations as a whole. This report provides 10 charts analyzing 13-month trends of several key
indicators, focusing on volume of Medical beneficiaries, admits and discharges, underserved populations, FSP
service usage, and summary of compliance audit results. The Dashboard Report is used to guide initiatives and
priorities that will be taken to clinics across the county. Since the report’s creation in November, the report
displays a steady increase in ratio and volume of enrolled medical beneficiaries. Future development to this
report is to create a division level version for both Ventura County Adult and Youth & Family Divisions.
Ventura County Behavioral Health
Recovery Innovations: VCBH continues their commitment to the training and employment of consumers in
peer positions at the out-patient clinics. As part of the continuous movement towards embedding peers into
the clinics and facilitating their integration as full partners in the treatment teams, the contract with Recovery
Innovations Inc. was improved. All adult and TAY out-patient clinics now have at least 1 full-time peer staff
who, in collaboration with the clinic team, identifies relevant training and support needs for consumers at the
clinic level and provides these at the site. In addition, a grant received under SB 82, VCBH added 4 peer
employees to the new RISE program, which will specifically target individuals with mental health illness who
require a crisis intervention and support services.
MHSA and Evaluation: Programs supported by the Mental Health Services Act have the principles of recovery
weaved into their purpose and expected outcomes and address the whole person – body, mind and spirit - and
emphasize the positive attributes of the individual. California passed Proposition 63, the Mental Health Services Act
(MHSA), in November 2004 to provide the California Department of Mental Health with additional funding to
achieve improved access and outcomes for the locally defined unserved and underserved populations needing
mental health care.
The MHSA encourages the participation of stakeholders in the decision-making of how resources are used. This
allows subject-matter experts from other agencies, general community members, consumers and family members
the opportunity to share their perspectives with VCBH and help ensure the implemented programs are optimal for
the community.
A key role of stakeholders is to help define, interpret and apply the evaluations of each program and the efforts of
the MHSA as a whole in Ventura County. Their work is done in conjunction with both internal quality improvement
staff and external evaluators to ensure the highest quality program reviews are possible. Regular, transparent
evaluation makes community-based data-driven decision making possible and informs the community what is going
well and where changes can be made.
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VCBH’s dedication to continuous quality improvement drives the growing of evaluation resources and in particular
by emphasizing the capacity building of partner organizations. Locally, MHSA funds are used to invest in training,
staff and technical resources to support data-collection, analysis and reporting in other agencies. For smaller groups
this effort can have the largest impact. The outreach and engagement projects serve as some of the best examples
of this partnership. These programs are community-based and offer targeted outreach activities and ongoing
programming and serves as a portal to mental health services if necessary. Over the course of their funded years,
program staff have worked with external evaluators and internal VCBH data specialists to learn about evaluation
techniques and data collection tools. Now these programs are able to provide their own outcome reports showing
their many activities and accomplishments.
Ventura County Behavioral Health
Working with our partners in turn changes the culture of data throughout MHSA programs making evaluations that
much richer, more effective and ultimately raising the quality of services available to the community.
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Consumer Comments
What have been your most helpful and positive experiences while receiving services at VCBH?
Preschool Parent
•"I feel better emotionally and more secure in my decisions.
•"Unconditional and focused one on one attention and dedication to me and
my son. I was given the true ability to speak and express my concerns for
myself and my son. I was taught to gain control as a parent. "
•"I learned to stay calm and consistent and experienced positive results."
•"Reassurance in my parenting and decision making."
•"Knowing you all truly care about these kids."
•"Encouragement/support. Reminds me it’s all a process, don’t give up."
•"Being told that all parents (not just me) have difficulties in regards to raising
our children, and that everything has a solution!"
•"(My therapist) ...is always available to answer all my questions and
genuinely cares for my son. She really has changed/saved his life and our
families."
Youth Self-Report
•“The times when I saw how far I came and that things are going to keep getting
better.”
•“Helping me to raise my grades.”
•“I'm less depressed and doing a lot better for myself than I was when I started
here. I've matured a lot and learn a lot of things that help me.
•“The people who work here show that they truly care about my health.”
Ventura County Behavioral Health
Youth Parent
Adult Self-Report
•"Compassion and professionalism from all employees, prompt service,
accessibility, involvement,and affordability."
•"Comfort in taking medication that saved my life."
•"Being treated with dignity, being listened to and the professionalism
provided."
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Fiscal Year 2013-2014