Mhsa CostOffset Report FSP byCounty 201304

Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Emotional Disturbance and Adults and Older Adults with Severe Mental Illness Contextual Factors and the Relationship to Expenditures and Cost Offsets UCLA Center for Healthier Children, Youth and Families The following report was funded by the Mental Health Services Oversight and Accountability Commission April 2013 Table of Contents Executive Summary ................................................................................................................................. i I. Introduction ..................................................................................................................................... 1 II. Involvement of Key Stakeholders ..................................................................................................... 3 1. Presentations to Client & Family Groups/Organizations Representing Unserved/ Underserved Groups ......................................................................................................... 3 2. Key Stakeholder Interviews with Individuals Representing Client & Family Groups/ Organizations Representing Unserved/Underserved Groups.............................................. 4 3. Presentations to Associations/Service Provider Agencies ................................................... 5 4. Interviews with Representatives from Associations/Service Provider Agencies .................. 5 5. Evaluation Advisory Group ................................................................................................ 7 6. Interviews with Peer Advocates & Parent Partners ............................................................ 9 7. Involvement of Key Stakeholders: Summary .................................................................... 12 III. Description of Full Service Partnership Programs ........................................................................... 13 a. Full Service Partnership Services .............................................................................................. 14 1. Outreach and Engagement .............................................................................................. 14 2. Assessment and Planning ................................................................................................ 15 3. Personal Service Coordinator/Case Manager ................................................................... 19 4. General Standards ........................................................................................................... 21 5. Outpatient Mental Health Services .................................................................................. 24 6. Other Supports ................................................................................................................ 26 7. Peer Support Services ...................................................................................................... 29 8. Housing ........................................................................................................................... 32 9. FSP Team Composition .................................................................................................... 33 10. Co-Occurring Disorders ............................................................................................... 34 11. Evidence-Based Practices ............................................................................................ 35 12. Other Practices ........................................................................................................... 48 13. Discharge Coordination .............................................................................................. 48 14. FSP Services Summary ................................................................................................ 49 IV. Expenditures on Full Service Partnership Programs ....................................................................... 51 a. Methodology........................................................................................................................... 51 1. Full Service Partnership Expenditures .............................................................................. 54 2. Age Groups ...................................................................................................................... 54 3. Housing ........................................................................................................................... 55 4. Outreach ......................................................................................................................... 56 5. Operational Definitions ................................................................................................... 57 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 6. Expenditure Calculations ................................................................................................. 58 7. Standardized Client Years ................................................................................................ 59 b. Per-Person Annualized Cost Average by Age Group ................................................................. 63 c. Contextual Factors – Relationship to Expenditures .................................................................. 64 d. Summary ................................................................................................................................. 71 V. Cost-Offsets for Full Service Partnership Programs ........................................................................ 72 a. Methodology........................................................................................................................... 73 1. New Enrollees ................................................................................................................. 75 2. Pre-Intake Period – 12 Months Prior to Enrolling in FSP: Annual per-Client Offset-Category Cost ................................................................................................................................. 76 3. Post-Intake Period – 12 Months Post-Enrollment into FSP: Annualized per-Client Offset- Category Cost .................................................................................................................. 77 b. Costs Offset by Age Group ....................................................................................................... 78 c. Contextual Factors – Relationship to Cost Offsets .................................................................... 81 d. Summary ................................................................................................................................. 82 Appendix A Evaluation Advisory Group Members ................................................................................ 84 Appendix B FSP Services by County ...................................................................................................... 86 Appendix C County FSP Expenditure by Age Group Web Survey ........................................................ 163 Appendix D County Participants ......................................................................................................... 177 Appendix E Revenue & Expenditure Reports ...................................................................................... 180 Appendix F Key Stakeholder Contacts ................................................................................................ 186 Appendix G FSP Expenditures by County ............................................................................................ 188 Appendix H FSP Cost Offsets by County .............................................................................................. 205 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Executive Summary Proposition 63 (2004) provides increased funding through the Mental Health Services Act (MHSA) to support mental health services for underserved and previously unserved individuals within the context of the public mental health system. Prop 63 funds are distributed to county departments of mental health to implement MHSA components. Components are: Prevention and Early Intervention (PEI); Workforce Education and Training (WET); Capital Facilities and Technological Needs (CF/TN); Innovation (INN); and Community Services and Supports (CSS), which includes the Full Service Partnership (FSP). CSS is designed to serve individuals with severe mental illness 1 (SMI) or serious emotional disturbance (SED). The focus of this report is the Full Service Partnership (FSP), which is designed to serve Californians in all phases of life who experience the most severe mental health challenges because of illness or circumstance. This population has been historically underserved and has substantial opportunity for benefits from improved access and participation in quality mental health treatment and support. FSP is grounded in earlier efforts, namely Assembly Bill 2034 (AB 2034) 2 and its predecessors. AB 2034 was unique in 1) its focus on serving homeless persons with serious mental illness; 2) the “housing first” mandate; 3) flexible funding; and 4) collection and reporting of client and system outcomes in “real time.” The final analysis of AB 2034 3 reported a percentage of costs offset of 49.8 percent. FSP services are a large portion of the Community Services and Supports (CSS) funding allocation from MHSA. CSS was designed to move the public mental health system beyond “business as usual” in order to improve access to more-effective services. CSS (particularly FSP) was intended to initiate significant changes in the system of care for 4 individuals with serious emotional disturbance/serious mental illness. There is a requirement that “the County shall direct the majority of its Community Services and Supports funds to 5 the Full-Service Partnership Service Category,” and that clients be served with “whatever it takes.” The remaining portions of CSS are intended to expand supportive services, such as transportation or vocational training (which are typically unfunded), crisis intervention and treatment. CSS and FSP services represent a commitment to improving mental health service to those Californians most in need. A recent report has shown FSP services to yield cost benefits statewide, yielding average savings in public cost attributable to the inadequately treated mental illness of FSP participants prior to program services that exceed the cost of those services – there is a cost savings of $1.27 for every Prop 63 dollar spent. The detailed report summarizing statewide findings may be found at: http://mhsoac.ca.gov/Meetings/docs/Meetings/2012/Nov/OAC_111512_Tab4_MHSA_CostOffset_Report_FSP.pdf FSP expenditures per client and cost offsets also vary substantially across counties. This report focuses on identifying those factors that are associated with this variation in expenditures and cost offset, including differences in the array of FSP services provided by counties, characteristics of the participant population, and characteristics of county context. More specifically, this report has the following major information objectives: Describe the array of FSP services planned by counties Document variation in numbers served and FSP expenditure-per-client across counties for Fiscal Year 09- 10 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page i Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Describe associations between service, participant, and county factors and FSP expenditure-per-client differences across counties Document variation in FSP cost offsets as percentage of FSP expenditures across counties Describe associations between service, participant, and county factors and differences in FSP cost offsets across counties Method The analysis presented here builds on prior expenditure and cost offset analyses conducted by the UCLA team. Findings from these analyses are presented in the report, Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Emotional Disturbance and Adults and Older Adults with Severe Mental Illness. The link to this report was provided on page i. In order to include a county in the FSP Expenditures and Cost Offsets Report, we needed Full Service Partnership expenditures broken out by age group. Per the California Code of Regulations, “The County shall provide services to all age groups i.e., older adults, adults, 6 transition age youth, and children/youth in the Full Service Partnership Service Category.” Age groups are defined as follows: 7 “Children and youth” means individuals from birth through 17 years of age. 8 “Transition Age Youth” means youth 16 years to 25 years of age. “Adult” means an individual 18 years of age through 59 years of age. 9 10 “Older Adult” means an individual 60 years of age and older. Accordingly, all findings for this analysis are reported separately by age group. Data collection and measurement procedures used for this analysis include: Expenditures and Cost Offset. County fiscal reporting varies substantially. In order to collect reliable and accurate data in a standardized format, expenditure data for this analysis were gathered through a web survey. All data were reported by Age Group. Almost all of the counties responded – 47 (81.0%). In addition, calculations were successfully completed for three (3) more counties that did not complete the web survey. These three counties aligned their CSS Plans, Annual Updates, and Revenue and Expenditure Reports (RER) in a consistent manner and broke out FSP programs into discrete age groups. Inclusion of the three (3) additional counties brings the total number of participants to 50 (86.2%). FSP Expenditures and Cost Offsets by Age Group for almost all of the counties are included in this report. Services. Information on the array of services provided in each county was coded from planning documents prepared by the counties. Measures of the number of service options, the number of evidence-based programs, and the number of peer-led programs were constructed from the coded data. Participant and county context measures were constructed from county databases developed for this study. The Community Services and Supports component section of the Three-Year Program and 11 Expenditure Plan (for the purpose of this report, we will refer to the part of the plan that addresses Community Services and Supports as the CSS Plan) and the attendant updates (Annual Updates through FY 10-11) served as the basis for the initial FSP review and summary conducted by UCLA. The FSP Service Assessment for each county/municipality was conducted using a systematic review and summary tool developed by a consultant formerly employed with a large county department of mental health and directly involved in the evaluation of that county’s MHSA program. The focus of the tool was straightforward – with instructions to trained reviewers to indicate whether planned services were present or absent in the CSS Plan and/or Annual Updates. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page ii Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets It is important to note that the estimates of expenditures are conservative. 12 Expenditures that are not clearly attributable to FSP clients have not been included, and cost savings estimates have been indexed to conservative estimates of expenditures. As is widely recognized, estimating the costs of savings attributable to service is complex – from both an expenditure estimate and a savings estimate point of view. At each step in these estimation processes, we have consciously adopted a conservative approach. All data collection, measurement, and analysis procedures and all measurement results were reviewed by the study Advisory Group. The strategy of document review and summary was selected after discussion with the FSP Evaluation Advisory Group, and by counties. These experts and stakeholders had the opportunity to comment on 13 method and result. Their input was incorporated into data collection, measurement procedures, and analysis. Description of FSP Services Differences in services provided may be an important factor in understanding county variation in FSP expenditure per client, and the magnitude of cost offsets in order to subsequently link specific services to specific age groups. Review of the Phase II Deliverable 1 MHSA Cost Report by county department of mental health stakeholders elicited feedback recommending description of Full Service Partnership programs, in order to provide the appropriate context within which to interpret findings. The strategy of document review and summary was selected after discussion with the FSP Evaluation Advisory Group, due to budget limitations and concerns about county/municipal burden inherent in a site visit/on-site service observation. The draft FSP Service Summary tool was reviewed at an FSP Evaluation Advisory Group meeting, and refined after that meeting. Based on the FSP Service Summary, the following services are offered across the state to FSPs (summarized in Table 1). Table 1. Full Service Partnership Services Summary 14 (Fiscal Year 06-07 through FY 09-10) Counties: Counties: Counties: Counties: Older Service Strategy CYF TAY Adults Adults Services/strategies indicated with an asterisk (*) (N=54) (N=59) (N=59) (N=54) represent requirements under the Mental Health Services Act. N % N % N % N % Outreach and Engagement* 53 98.1% 59 100% 59 100% 54 100% Personal Service Coordinator/Case Manager* 52 96.3% 58 98.3% 59 100% 52 96.3% General Standards* 54 100% 59 100% 59 100% 54 100% Outpatient Mental Health Services 51 94.4% 58 98.3% 56 94.9% 50 92.6% Other Supports 48 88.9% 57 96.6% 56 94.9% 48 88.9% Specific Positions for Clients/Family Members 51 94.4% 57 96.6% 56 94.9% 51 94.4% Strategies Involving Peers on Team 50 92.6% 54 91.5% 55 93.2% 50 92.6% Peers Augmenting Overall Team Capacity 48 88.9% 58 98.3% 57 96.6% 53 98.1% Housing 40 74.1% 55 93.2% 55 93.2% 43 79.6% Best practices – Team Composition 33 61.1% 42 77.8% 44 74.6% 43 79.6% Services for Comorbidity 28 51.9% 49 83.1% 49 83.1% 38 70.4% Evidence-Based Practices 41 75.9% 45 76.3% 49 83.1% 32 59.3% Other Practices 30 50.9% 30 50.9% 33 55.9% 26 66.7% Discharge Coordination 33 61.7% 40 67.8% 37 62.7% 27 50.0% Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page iii Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets The data in Table 1 supports the following findings regarding services offered to FSPs: Outreach and Engagement At least one of the required strategies are in place for outreach and engagement in all counties serving TAY, Adults and Older Adults, and nearly all counties serving CYF. Personal Service Coordinator/Case Manager A Personal Service Coordinator/Case Manager for each client (and when appropriate, the client’s family) 15 to be the single point of responsibility for that client/family are in place for FSPs in all counties serving Adults, and in nearly all counties serving other age groups. General Standards Incorporation of required MHSA General Standards when providing services to FSPs was documented by all counties. Outpatient Mental Health Services Outpatient mental health services are offered in 92.6 to 98.3 percent of the counties to FSPs, depending upon the age group served. o Other support services are offered in 88.9 to 96.6 percent of counties, depending upon the age group served by the FSP Clients and Family Members on the FSP Team The inclusion of consumers/family members on staff was documented for nearly all counties - 94.4 to 96.6 percent of the counties. Up to 98.3 percent of counties (all serve Adults) noted ways in which clients and family members were planned to augment the team, but not all cited specific roles or current employment of peers/parent advocates. Housing 16 Depending upon the age group served by the FSP, housing is offered in 68.5 to 94.9 percent of counties. Best Practices Specific best practices with regard to team composition were cited by 61.1 to 79.6 percent of counties, depending upon the age group served by the FSP team. Linkage to substance abuse treatment for FSPs with co-occurring disorders was documented by 51.9 to 83.1 percent of counties, depending upon the age group. The majority of counties cited at least one evidence-based practice provided to each of the age groups served by the FSP (59.3 to 83.1%). More than half (59.3 to 67.8% of counties, depending upon the age group) document specific practices around discharge planning. FSP Service Expenditures FSP services are intended to meet the needs of FSP-targeted clients. This is driven primarily by the policy objective to meet the serious needs of the hardest-to-serve clients – those with severe mental illness. This policy objective includes meeting both the service and the quality-of-life needs of FSP clients and the social outcomes and services needs of California. To address this complex balance between policy objective and client needs, this study has Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page iv Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets assessed a broad range of costs to citizens of California that are a consequence of service delivery to mental health clients most in need. More specifically, Fiscal years included in the study period are Fiscal Year 2008-09 (FY 08-09) and FY 09-10. The two fiscal years were selected because: o Outcome data are most robust and complete in these two fiscal years, and o Revenue and Expenditure Reports in these two fiscal years are broken out by FSP program, allowing a drill-down (with county input) to expenditures by age group. The annualized expenditure per FSP client year is presented below, in Tables 2 through 5. 17 Annualized expenditure is the total expenditure for an FSP client over a year (12 months). 18 The data in Tables 2 and 3 reflect FY 08-09, and the data in Tables 4 and 5 reflect FY 09-10. The statewide total for each age group is provided in Tables 2 and 4, as well as the range among counties from low to high. The statewide average for each age group is provided in Tables 3 and 5, as well as the range among counties from low to high. 19 Table 2. Full Service Partnership Services: Numbers Served by Age Group 20 (Fiscal Year 08-09) Number Served Sum of Days Number of Client Years Age Group Total Low High Total Low High Total Low High CYF 4,296 9 2,223 983,187 1,369 580,545 2,693.7 3.8 1,590.5 TAY 4,593 25 1,257 1,064,015 6,517 333,383 2,915.1 17.9 913.4 Adults 9,640 37 4,176 2,404,022 9,000 1,148,521 6,586.4 24.7 3,146.6 Older Adults 1,388 1 373 344,979 7 98,535 945.1 <.1 270.0 21 Table 3. Full Service Partnership Services: Annualized Expenditure per-Client by Age Group (Fiscal Year 08-09) 22 Annualized Expenditure per- FSP Client Daily Expenditure per-FSP FSP Service Expenditure Total Client Age Group Average Low High Average Low High Total Low High CYF $21,931.29 $3,759.79 $72,054.99 $60.09 $10.30 $197.41 $59,076,305.79 $86,851.14 $27,863,702.00 TAY $18,553.96 $6,753.44 $92,470.00 $50.83 $18.50 $253.34 $54,086,655.41 $352,529.77 $21,698,945.60 Adults $26,737.23 $6,815.18 $64,318.98 $73.25 $18.67 $176.22 $176,102,066.30 $254,338.00 $81,947,433.40 Older Adults $22,303.26 $14,593.75 $112,063.43 $61.10 $41.06 $307.02 $21,078,807.79 $64,976.01 $5,720,395.00 Tables 4 and 5 display the same type of information about numbers served and expenditures as in Tables 2 and 3, but for Fiscal Year 09-10. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page v Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 23 Table 4. Full Service Partnership Services: Numbers Served by Age Group 24 (Fiscal Year 09-10) Number Served Sum of Days Number of Client Years Age Group Total Low High Total Low High Total Low High CYF 6,348 5 3,165 1,444,331 780 820,496 3,957.1 2.1 2,247.9 TAY 6,623 36 1,702 1,619,816 8,444 477,643 4,437.9 23.1 1,308.6 Adults 12,733 39 4,541 3,456,407 3,630 1,357,732 9,469.6 9.9 3,719.8 Older Adults 1,764 1 406 480,383 365 124,740 1,316.1 1 341.8 25 Table 5. Full Service Partnership Services: Annualized Expenditure per-Client by Age Group 26 (Fiscal Year 09-10) Annualized Expenditure per- FSP Daily Expenditure per-FSP FSP Service Expenditure Total Client Client Age Group Average Low High Average Low High Total Low High CYF $17,481.79 $3,933.95 $54,663.66 $47.90 $10.78 $149.76 $69,177,192.53 $82,641.89 $40,675,886.00 TAY $13,741.40 $5,584.11 $54,570.82 $37.65 $15.30 $129.51 $60,982,974.12 $287,581.77 $22,853,881.40 Adults $23,626.13 $5,066.28 $55,558.11 $64.73 $13.88 $261.41 $223,729,986.45 $320,491.79 $113,766,228.00 Older Adults $18,785.22 $9,538.23 $162,106.00 $51.47 $26.13 $141.99 $24,723,227.99 $43,553.21 $6,412,015.00 The age breakouts reveal that FSP services for Adults comprise most of the expenditures in both fiscal years. Average daily expenditure on FSP clients in each age group varies substantially across counties. Table 6 displays information about possible factors of service populations, the kinds of services provided by counties, and characteristics of the counties themselves that may contribute to differences between the average county FSP expenditure per client. These county-level factors were subsequently analyzed using multivariate statistics in order to determine the relationship to the average FSP expenditure in each county. Hence, the purpose was comparison of county-level variables (not individual-level variables). Table 6. Description of County-Level Variables - Total FSP Average Daily Expenditure per County CYF Average TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure The number of counties for which we have daily expenditure data. An average Number of Counties for each age group was calculated, in order to produce a county-level variable, to compare with other county-level variables. The total number of FSP activities/strategies offered in the county (see Number of Service Options Appendix B). The total number of FSP evidence-based activities/strategies offered in Evidence-Based Services the county (see Appendix B). The total number of FSP activities/strategies led by peers in the county Peer Services (see Appendix B). The Penetration Rate is a ratio estimate of the prevalence of serious Penetration Rate mental illness/serious emotional disturbance in California (developed by Dr. Charles Holzer from the University of Texas). Population density was created for each county using county population and Population Density square miles of the county. Percent County Population Insured Percent of county population with health insurance. 2009 Poverty and Median Income Estimates – Counties; Poverty Level Source: U.S. Census Bureau, Small Area Estimates Branch The California Employment Development Department (CA EDD) defines Unemployment Rate “Unemployment Rate” as the number of unemployed divided by the labor force then multiplied by 100. Rate of Foreclosures Rate of foreclosures in the county. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page vi Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets A series of multivariate analyses were conducted in order to determine the relationship between average expenditure by age group and county factors. Analyses completed included: Regression General Linear Model ANOVA MANCOVA None of the multivariate models yielded meaningful results, resulting in return to examining the correlational matrices produced during the process of conducting multivariate analyses. The results are displayed in Table 7. Table 7 provides information on possible factors of service populations, the kinds of services provided by counties, and characteristics of the counties themselves that may contribute to differences between the average county FSP expenditure per age group. Table 7 displays correlations between select characteristics of services provided (number of service options offered in the county, number of evidence-based options, number of peer led services offered); and characteristics of the county environment 27 (penetration rate, 28 population density, 29 percent of county population with health insurance, 30 poverty level, 31 county unemployment rate, 32 and rate of 33 foreclosures). Table 7. Correlations (Pearson’s) of FSP Services, and County Characteristics to Total FSP Average Daily Expenditures for Counties (Fiscal Year 09-10) CYF TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Number of Counties 34 39 42 31 Number of Service Options -0.120 -0.262 -0.011 -0.290 Evidence-Based Services -0.102 -0.171 0.133 -0.225 Peer Services -0.070 0.034 0.050 -0.230 Penetration Rate -0.070 -0.140 0.006 -0.156 Population Density 0.180 -0.177 0.077 -0.078 Percent County Population Insured 0.420* 0.095 -0.067 -0.164 Poverty Level -0.373* -0.208 -0.212 0.066 Unemployment Rate -0.310 0.115 -0.173 0.057 Rate of Foreclosures -0.179 0.144 -0.264 0.191 *Correlation is significant at the .05 level The results displayed in Table 7 highlight the: 1. relatively small degree to which these factors are associated with the average FSP daily expenditure across counties, 2. presence of only one factor that shows a consistent direction of association with the average daily FSP expenditure across all age groups (number of service options – negative correlation for each age group), CYF TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Number of Service Options -0.120 -0.262 -0.011 -0.290 and Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page vii Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 3. degree to which other factors related to the average FSP daily expenditure differ across participant age groups (e.g., unemployment rate is negatively correlated with CYF and Adult Daily expenditure and positively correlated with TAY and Older Adult Daily expenditure. In addition, the correlation is moderate for CYF, and very small for the other age groups) CYF TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Unemployment Rate -0.310 0.115 -0.173 0.057 With respect to the relatively small magnitude of association as measured by these coefficients, two associations reach a level of statistical significance, but only for CYF expenditures (percent of county population insured and poverty level). Please note that correlation does not equal causation – association merely means that two variables are related to one another, not that one variable changed the other variable in any way: Percent of Population Insured: Higher percentages of children with insurance were correlated (at .05 significance level) with higher average daily FSP expenditure for CYF. Poverty Level: Lower percentages of families with children living in poverty were correlated (at .05 significance level) with higher average daily expenditure for CYF. In order to examine select characteristics of FSP participants (gender, race/ethnicity), 34 additional correlational analyses were conducted. An explanation of the variables used in analysis is provided below, in Table 8, and the results are displayed in Table 9. Table 8. Description of FSP-Level Variables - Total FSP Average Daily Expenditure CYF Average TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Gender The proportion of Caucasian FSPs (by age group) in each county. Race The proportion of FSPs (by age group) in each county that are Male. Table 9. Correlations (Spearman’s Rank Order) of FSP Characteristics to FSP Average Daily Expenditures (Fiscal Year 09-10) CYF TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Number of Counties 34 39 42 31 Gender -0.175 -0.066 0.116 -0.437* Race 0.458* 0.404* 0.150 0.126 *Correlation is significant at the .05 level (2-tailed) Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page viii Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets The results displayed in Table 9 highlight the: 1. relatively moderate degree to which FSP characteristics are associated with the average FSP daily expenditure for some age groups across counties (compared to county characteristic variables), CYF TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Gender -0.175 -0.066 0.116 -0.437* ← Race 0.458* 0.404* 0.150 0.126 ↑ ↑ 2. presence of one factor that shows a consistent direction of association with the average daily FSP expenditure across all age groups (race – proportion of White/Caucasian FSPs – positive correlation for each age group), and CYF TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Race 0.458* 0.404* 0.150 0.126 3. the degree to which gender is largely unrelated to the average FSP daily expenditure, with the exception of Older Adults 35 CYF TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Gender -0.175 -0.066 0.116 -0.437* ← With respect to the relatively moderate magnitude of association as measured by these coefficients, three associations reach a level of statistical significance. Please note that correlation does not equal causation – association merely means that two variables are related to one another, not that one variable changed the other variable in any way: Race/Ethnicity: Higher percentages of white (Caucasian) FSPs served by a county were associated with higher average daily FSP expenditure for CYF and TAY (at .05 significance level). These results are depicted graphically in Exhibits 1 through 2. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page ix Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Exhibit 1. Relationship of CYF Race/Ethnicity to FSP Average Daily Expenditures (Fiscal Year 09-10) Exhibit 2. Relationship of TAY Race/Ethnicity to FSP Average Daily Expenditures (Fiscal Year 09-10) Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page x Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Cost Offsets of Full Service Partnership Services Tables 10 through 13 represent service expenditures and costs saved as a result of service for FY 08-09 (Tables 10 and 11) and FY 09-10 (Tables 12 and 13) for new enrollees in FSP. Cost-offset analysis is limited to new enrollees for the following reasons: The baseline intake assessment (documented on the Partnership Assessment Form) contains questions about service use in offset categories of interest in the 12 months prior to FSP enrollment. The post-FSP period, therefore, should be equivalent to the pre-intake period (no more than 12 months), in order to compare the proverbial “apples to apples.” Given that the two fiscal years of focus are 08-09 and 09-10, the logical groups for inclusion in analyses were new enrollees in FY 08-09 and new enrollees in FY 09-10. Cost offsets are calculated for each individual FSP client (e.g., number of inpatient psychiatric hospitalization days in the 12 months prior to FSP and the 12 months post-FSP enrollment). More specifically, Cost offsets are the total differential between the cost of mental and physical health services, and criminal justice involvement costs in the year prior to entry into FSP services and the average 12-month cost after entry into services. 36 This is the amount of public money in these areas that was saved after these clients had access to service. Full Service Partnership Cost Offsets by Age Group include: Physical Health Acute Care Inpatient Hospitalization (number of days) Skilled Nursing (Non-Psychiatric) (number of days) Emergency Room Visits (number of times) Psychiatric Care Inpatient Psychiatric Hospitalization (number of days) Long-Term Care (number of days) Skilled Nursing (Psychiatric) (number of days) Criminal Justice Involvement Arrests (number of times) Division of Juvenile Justice (number of days) Juvenile Hall/Camp (number of days) Jail (number of days) Prison (number of days) Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page xi Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 37 Table 10. Full Service Partnership Services: Number of New Enrollees by Age Group 38 (Fiscal Year 08-09) Number of New Sum of Days Enrollees FY 08-09 Age Group Total Low High Total Low High CYF 2,164 9 2,223 340,323 1,369 580,545 TAY 2,327 25 1,257 371,250 6,517 333,383 Adults 4,315 37 4,176 690,298 9,000 1,148,521 Older Adults 582 1 373 91,220 7 98,535 39 Table 11. Full Service Partnership Services: Expenditures and Cost Offsets by Age Group 40 (Fiscal Year 08-09) Total Expenditures for FY 08-09 New Total Cost Offset FY 08-09 Enrollees Age Group Total Low High Total Low High CYF $20,450,009.07 $3,759.79 $72,054.99 $2,428,313.16 $86,851.14 $27,863,702.00 TAY $18,870,637.50 $6,753.44 $92,470.00 $22,437,417.44 $352,529.77 $21,698,945.60 Adults $50,564,328.50 $6,815.18 $64,318.98 $41,509,329.01 $254,338.00 $81,947,433.40 Older Adults $5,573,542.00 $14,593.75 $112,063.43 $5,421,665.55 $64,976.01 $5,720,395.00 Tables 12 and 13 display the same type of information about numbers served, expenditures and cost offsets as in Tables 10 and 11, but for Fiscal Year 09-10. 41 Table 12. Full Service Partnership Services: Number of New Enrollees by Age Group 42 (Fiscal Year 09-10) Number of New Sum of Days Enrollees FY 09-10 Age Group Total Low High Total Low High CYF 3,101 9 2,223 454,605 1,369 580,545 TAY 2,977 25 1,257 496,190 6,517 333,383 Adults 4,702 37 4,176 868,415 9,000 1,148,521 Older Adults 645 1 373 103,459 7 98,535 43 Table 13. Full Service Partnership Services: Expenditures and Cost Offsets by Age Group 44 (Fiscal Year 09-10) Total Expenditures for FY 09-10 New Total Cost Offset FY 09-10 Enrollees Age Group Total Low High Total Low High CYF $21,775,579.50 $3,759.79 $72,054.99 $2,262,842.11 $86,851.14 $27,863,702.00 TAY $18,681,553.50 $6,753.44 $92,470.00 $27,501,007.94 $352,529.77 $21,698,945.60 Adults $56,212,502.95 $6,815.18 $64,318.98 $56,120,875.82 $254,338.00 $81,947,433.40 Older Adults $5,325,034.73 $14,593.75 $112,063.43 $3,857,684.17 $64,976.01 $5,720,395.00 The findings displayed in Tables 10 through 13 support the following conclusions: Cost savings over the two-year period are consistent in relative magnitude across age groups. In particular, TAY consumers experienced the greatest cost-related benefits of service. Transition-Age Youth are at high risk for criminal justice and crisis management services, and FSP participation apparently has a significant impact on consequences for this age group. Cost offsets are dramatically lower for the CYF age group. This may reflect the more preventive orientation of services for children, which is not as clearly reflected in the short time line of the measured Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page xii Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets offsets. Savings for children may appear over a much longer period of time, outside the currently funded study period. In addition, the “consequence” nature of the offset categories examined (e.g., criminal justice involvement) is more relevant to older age cohorts. Effects of service are sensitive to life maturation, indicators of service success and the time horizon of measured effects. Overall, across all age groups, 75 and 88 percent of FSP expenditures for new enrollees in FY 08-09 and FY 09-10 (respectively) are offset by savings to the public mental health, health and justice systems. Although the argument of cost savings should never be advanced as the primary reason for providing public mental health services, results of this magnitude make a strong case for the wisdom of investing public resources in programs such as the Full Service Partnership. In summary, this analysis of cost offsets in larger social costs attributable to participation in the FSP program documents positive results. Results for the TAY and Adult age groups, which account for the great majority of clients, are particularly positive. These results are quite favorable when compared with AB 2034, a program charged with serving homeless (or at risk of becoming homeless) TAY and Adults with severe mental illness – the final analysis reported a percentage of costs offset of 49.8 percent. In addition, an analysis of county contextual variables that may be related to cost offsets was conducted. This analysis (and the multivariate analyses preceding the results shown below) parallels the analysis of average daily FSP expenditures (Table 7). Variable definitions and analysis technique are the same as those described in that section. The dependent variable is total cost offset as a percentage of total cost. Table 14 displays associations, as measured by Pearson’s correlation coefficients, between the individual, service, and county environment characteristics identified above, and average cost offset for each county. The pattern of association for cost offsets is quite different than that identified for expenditures. Table 14 demonstrates the following patterns in association across the age groups. Table 14. Correlations (Pearson’s) of FSP Services and County Characteristics to Average Cost Offsets for Counties (Fiscal Year 09-10) CYF TAY Adult Older Adult Average Cost Average Cost Average Cost Average Cost Offset Offset Offset Offset Number of Counties 34 39 42 31 Number of Service Options -0.382* 0.048 -0.011 0.293 Evidence-Based Services -0.248 0.025 -0.113 0.233 Peer Services -0.314 -0.077 -0.070 0.100 Penetration Rate -0.057 -0.351* 0.263 0.292 Population Density 0.103 -0.251 -0.238 -0.236 Percent County Population Insured 0.196 0.095 -0.212 -0.301 Poverty Level -0.150 -0.208 0.176 0.168 Unemployment Rate -0.133 0.115 -0.100 -0.030 Rate of Foreclosures 0.083 0.088 0.005 0.019 *Correlation is significant at the .05 level (2-tailed) The results displayed in Table 14 highlight the: 1. relatively small degree to which these factors are associated with the FSP average cost offset across counties, 2. presence of only one factor that shows a consistent direction of association with the FSP average cost offset across all age groups (rate of foreclosures – positive correlation with each age group), and Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page xiii Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets CYF TAY Adult Older Adult Average Cost Average Cost Average Cost Average Cost Offset Offset Offset Offset Rate of Foreclosures 0.083 0.088 0.005 0.019 3. degree to which other factors related to the FSP cost offsets differ across participant age groups (e.g., poverty level is negatively correlated with CYF and TAY average cost offset and positively correlated with Adult and Older Adult average cost offset) Please note that correlation does not equal causation – association merely means that two variables are related to one another, not that one variable changed the other variable in any way: Number of Service Options is associated with offsets for CYF. o The greater number of services offered, the lower average cost offset among CYF (significant at .05 level). In plain language, offering more services for CYF is not associated with greater cost offsets in the near term. However, it is not possible to know the impact after one year – CYF cost offsets may not be likely to appear until many years later, perhaps even into adolescence or young adulthood. Penetration Rate (ratio estimate of the prevalence of serious mental illness/serious emotional disturbance) is associated with offsets in all but the CYF group, but varies across age groups. o For TAY participants, a higher penetration rate is related (at .05 significance level) to lower average cost offset in counties. In order to examine select characteristics of FSP participants (gender, race/ethnicity), additional correlational analyses were conducted. The results are displayed in Table 15. Table 15. Correlations (Spearman’s Rank Order) of FSP Characteristics to FSP Average Cost Offset (Fiscal Year 09-10) CYF TAY Adult Older Adult Total Cost Total Cost Total Cost Total Cost Offset Offset Offset Offset Number of Counties 34 39 42 31 Gender 0.298 0.217 0.166 -0.097 Race -0.025 -0.054 0.142 -0.037 *Correlation is significant at the .05 level (2-tailed) The results displayed in Table 15 highlight the relatively small degree to which FSP characteristics are associated with the FSP average cost offset across counties. The descriptive analyses examining participant characteristics suggests that cost offsets are less related to these factors than is daily service expenditure. Summary CSS and FSP services represent a commitment to improving mental health service to those Californians most in need. A wide variety of service strategies are offered under FSP (selected highlights below): Outreach and Engagement (all counties) Personal Service Coordinator (all counties) Outpatient Mental Health Services (over 90% of counties) Client/Family Member on the Team (95% of counties) Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page xiv Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets A recent report has shown FSP services to yield cost benefits statewide, yielding average savings in public cost attributable to the inadequately treated mental illness of FSP participants prior to program services that exceed the cost of those services – there is a cost savings of $1.27 for every Prop 63 dollar spent. FSP expenditures per client and cost offsets vary substantially across counties. The age breakouts reveal that FSP services for Adults comprise most of the expenditures – yet when participant and county characteristics were analyzed in order to determine potential association with FSP expenditures, significant relationships between county and participant characteristics were only identified for CYF, TAY and Older Adults (correlations in the moderate range): Percent of Population Insured: Higher percentages of children with insurance were correlated with higher average daily FSP expenditure for CYF. Poverty Level: Lower percentages of families with children living in poverty were correlated with higher average daily expenditure for CYF. Race/Ethnicity: Higher percentages of white (Caucasian) FSPs served by a county were associated with higher average daily FSP expenditure for CYF and TAY. Cost savings over the two-year period are consistent in relative magnitude across age groups. In particular, TAY consumers experienced the greatest cost-related benefits of service. Transition-Age Youth are at high risk for criminal justice and crisis management services, and FSP participation apparently has a significant impact on consequences for this age group. Penetration Rate (ratio estimate of the prevalence of serious mental illness/serious emotional disturbance) is associated with lower average cost offset for TAY across counties. Cost offsets are dramatically lower for the CYF age group. This may reflect the more preventive orientation of services for children, which is not as clearly reflected in the short time line of the measured offsets. Savings for children may appear over a much longer period of time, outside the currently funded study period. In addition, the “consequence” nature of the offset categories examined (e.g., criminal justice involvement) is more relevant to older age cohorts. Effects of service are sensitive to life maturation, indicators of service success and the time horizon of measured effects. Number of Service Options is associated with offsets for CYF, in that the greater number of services offered, the lower average cost offset among CYF. In plain language, offering more services for CYF is not associated with greater cost offsets in the near term. However, it is not possible to know the impact after one year – CYF cost offsets may not be likely to appear until many years later, perhaps even into adolescence or young adulthood. Overall, across all age groups, 75 and 88 percent of FSP costs for new enrollees in FY 08-09 and FY 09-10 (respectively) are offset by savings to the public mental health, health and justice systems. Although the argument of cost savings should never be advanced as the primary reason for providing public mental health services, results of this magnitude make a strong case for the wisdom of investing public resources in programs such as the Full Service Partnership. The moderate relationships between FSP expenditures, cost offsets and county/participant characteristics suggest other factors relate to variation between counties. Additional investigation is needed in order to determine county, service and client characteristics that may impact FSP expenditures and cost offsets. For example, clinical diagnosis has been shown in a previous study to be an important covariate, and encounter data at the unit of 45 service level a critical outcome variable (particularly use of outpatient services). Neither variable was available Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page xv Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets for analysis given the need to rely largely upon available data sources for the current study. Fidelity to implementation of evidence-based practices and other quality of service indicators merit further investigation, given the logical relationship to outcomes. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page xvi Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Definition of Terms DEFINITION OF TERMS 3M Quarterly Assessment AB Assembly Bill CF Capital Facilities CFTN Capital Facilities and Technological Needs CMHDA California Mental Health Directors Association CSA Corrections Standards Authority CSI Client Services Information System CSS Community Services and Supports CYF Children, Youth and Families DCR Data Collection and Reporting System for MHSA FSP DJJ Division of Juvenile Justice DMH Department of Mental Health DNR Agency did not report costs DOF Department of Finance EAG Evaluation Advisory Group ER Emergency Room FFP Federal Financial Participation FSP Full Service Partner or Full Service Partnership FY Fiscal Year GSD General System Development IMD Institution for Mental Diseases INN Innovation IMPACT Improving Mood – Promoting Access to Collaborative Treatment JHC Juvenile Halls and/or Camps KET Key Event Tracking LAO Legislative Analyst’s Office LGBTQ Lesbian, Gay, Bisexual, Transsexual/Transgendered and Questioning MH Mental Health MHRC Mental Health Rehabilitation Centers MHSA Mental Health Services Act MHSOAC Mental Health Services Oversight and Accountability Commission (also OAC) NC No Camp NJH No Juvenile Hall NJHC No Juvenile Hall or Camp OA Older Adults OSHPD Office of Statewide Health Planning and Development PAF Partnership Assessment Form PEI Prevention and Early Intervention POQI Performance Outcomes & Quality Improvement RER Revenue and Expenditure Reports RFA Request for Applications RFP Request for Proposal SAMHSA Substance Abuse and Mental Health Services Administration SB Senate Bill SED Serious Emotional Disturbance SGF State General Fund SMA Statewide Maximum Allowance SMI Severe Mental Illness SMHA State Mental Health Authority SPSS Statistical Package for the Social Sciences TAY Transition-Age Youth TN Technological Needs Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page xvii Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets DEFINITION OF TERMS WET Workforce Education and Training WIC Welfare and Institutions Code YSS Youth Services Survey YSS-F Youth Services Survey for Families Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page xviii Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Executive Summary End Notes 1 The system of care is addressed in: California Welfare and Institutions Code (WIC), Division 5. Community Mental Health Services, Part 3. Adult and Older Adult System of Care Act. Article 1. Legislative Findings and Intent (5801 – 5802) and Article 2. Establishing New County Systems of Care (5803 – 5809) and Part 4. The Children’s Mental Health Services Act. Chapter 1. Interagency System of Care (5850 – 5851.5). Certified as current (January 18, 2013). Note that the direct web link to WIC specific to the Mental Health Services Act requires search onsite, using the link below: http://leginfo.legislature.ca.gov/faces/codes.xhtml CSS is addressed in: California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, Community Services and Supports, 3200.080. Note that the direct web link to CCR specific to the Mental Health Services Act requires search onsite, using the link below, http://government.westlaw.com/linkedslice/default.asp?RS=GVT1.0&VR=2.0&SP=CCR-1000&Action=Welcome Full Service Partnership is further addressed in: California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620. Full Service Partnership Service Category. Subsection (c). 2 Per the Corporation for Supportive Housing (undated report), AB 2034 Program experiences in housing homeless people with serious mental illness: The state legislature started laying the foundation for MHSA back in 1999 when it passed AB 34, which provided $10 million for pilot programs through the mental health departments in Los Angeles, Sacramento and Stanislaus counties. Based on the success of that effort, funding increased dramatically in FY 00-01 under AB 2034. AB 2034 provided the resources necessary to expand existing pilots and create additional programs statewide. (p. 1) In summary, there are many predecessors to Prop 63. Others include AB 34 and AB 3777. 3 California Department of Mental Health (2007). (unpublished) Report to the Legislature on the effectiveness of integrated services for homeless adults with serious mental illness. Sacramento, CA: Author. (p. 3) Data collected from November 1, 1999 – January 31, 2007. $55 million in costs, $27.4 million in offsets (psychiatric hospitalization, incarceration and emergency room use for psychiatric episodes). 4 Please refer to End Note #1. 5 Full Service Partnership is addressed in: California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620. Full Service Partnership Service Category. Subsection (c). 6 Alignment of plan, update, RER, plus breakout of discrete FSP programs into distinct age groups was a rarity among the counties, but this should not be viewed as a “negative” on the part of the counties, because the original intent of the RER had nothing to do with breakouts by age group. Note that one county was in start-up during the entire study period, and was therefore removed from the total N for purpose of this study. No comparable data was available for analysis – this is the reason for removal. Therefore, the N = 58 (rather than 59). California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620 Full Service Partnership Service Category. Subsection (j). 7 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions. 3200.030. Children and Youth: (1) Individuals age 18 and older who meet the conditions specified in Chapter 26.5 (commencing with Section 7570) of Division 7 of Title 1 of the Government Code are considered children and youth who are eligible to receive services. 8 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.280. Transition Age Youth. 9 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.010. Adult. 10 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.230. Older Adult. 11 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 3. General Requirements, 3310. The Three-Year Program and Expenditure Plan. Subsection (b) (1). 12 The most conservative estimate of cost offsets would involve accessing consequence data directly from providers – jails, prisons, etc. However, this was not feasible from either a time or a study-cost perspective. Therefore, self-report data were relied upon in order to estimate days in jail, prison, etc. Note that the term “cost offsets” is used, compared to “expenditures” when discussing the daily average expenditure per FSP. The term “cost” is used in reference to offsets because the unit of analysis is the actual cost (recognized as accurate by a governmental agency, either at the state or at the county level) incurred to providers when providing a “service,” whether it be the cost of inpatient psychiatric hospitalization for one day, the daily cost of incarceration, or the cost of an emergency room visit – the official source for each agency cost is discussed extensively in the report, Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Emotional Disturbance and Adults and Older Adults with Severe Mental Illness: http://mhsoac.ca.gov/Meetings/docs/Meetings/2012/Nov/OAC_111512_Tab4_MHSA_CostOffset_Report_FSP.pdf and therefore need not be repeated here. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page xix Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 13 Documentary review was selected as the method due to budget limitations and concerns about county/municipal burden inherent in a site visit/on-site service observation. See Appendix A for a list of Evaluation Advisory Group members. Following the FSP Service Summary, counties/municipalities had the opportunity to review their individualized FSP Services Assessment, and to provide supplementary documentation for consideration in the event that critical services were not documented in the CSS Plan or Annual Updates. When supplementary documentation was provided by a county or municipality, its specific, individualized FSP Service Summary was updated to reflect new information. The FSP Service Summary includes documentation of the source material, for county/municipal reference. Because of the opportunity for counties to review and comment on planned FSP services, and to make corrections where necessary, the services summarized in Table 1 (above) may reasonably be considered to be implemented for FSPs (rather than simply planned). 14 See Appendix B for FSP services by county and age group – not all age groups were served in all counties during the study period. 15 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620. Full Service Partnership Service Category. Subsection (f). 16 Housing, for the purpose of this study, is defined as: 1) Project-Based Housing Program, per California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3630.05. Project-Based Housing Program. Per Subsection (a): The County may use General System Development funds for costs associated with Project-Based Housing… 2) Mental Health Services Act Housing Program Service Category, per California Code of Regulation (Barclays Official), Title 9. Rehabilitative and Developmental Services, Division 1. Department of Mental Health, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.225. Mental Health Services Act Housing Program Service Category. “Mental Health Services Act Housing Program Service Category” means the service category of the Community Services and Supports component of the Three-Year Program and Expenditure Plans under which Mental Health Services Act funds, administered through the California Housing Finance Agency, are used to acquire, rehabilitate, or construct permanent supportive housing for clients with serious mental illness and provide operating subsidies. 17 For more details on methods related to the cost-offset study, see Chapter IV of the full Report. 18 Annualization of the service period is the same methodology used by the California Department of Mental Health when evaluating and reporting on AB 2034 outcomes. California Department of Mental Health (2007). (unpublished) Report to the Legislature on the effectiveness of integrated services for homeless adults with serious mental illness. Sacramento, CA: Author. 19 Small counties have been pooled for the purpose of summarizing the data in Tables 2 – 5, and in Appendix G. For Tables 2 – 5, small county data was pooled as a means of dealing with skew (as opposed to transformation, which would not be appropriate for purpose of display in Tables 2 - 5), based upon Evaluation Advisory Group recommendation. For Appendix G, small county data was pooled for purpose of display based upon the recommendation of the Evaluation Advisory Group. This recommendation was based upon the lower number of FSPs served in smaller counties, and what would amount to an unfair comparison if aligned in a table containing larger counties. Pooling of small counties aggregates the small county data, allowing for a fairer comparison to their larger counterparts. Small counties were not pooled in all tables/analyses, and thus it is noted when pooling occurred. In addition, small counties were pooled in the following report: Mental Health Services Act Evaluation: Compiling Community Services and Supports (CSS) Data to Produce All Priority Indicators Contract Deliverable 2F, Phase II, available for download at: http://www.mhsoac.ca.gov/Evaluations/docs/CompilingCSSDataToProducePriorityIndicators_2FPhase2_121812.pdf 20 See Appendix G for a display of the data shown in this table, by county. 21 See End Notes 18 and 19. 22 Ibid. 23 Ibid. 24 Ibid. 25 Ibid. 26 Ibid. 27 Of course, cost savings in individual counties could be attributable to many plausible alternative influences other than FSP enrollment, particularly additional services from other programs in that county. However, these influences would not adequately explain aggregate state- level savings. 28 UCLA updated the Penetration Rate for each county to reflect the relevant year and applicable census data, per the following notation from DMH: When considering these penetration rates, it is important to remember that they are based on census data combined with estimates that were calculated by applying prediction weights. Due to the way census data is updated, the data in the tables should be viewed as "best available" and should be checked and/verified at the local level where numbers do not appear to represent actual local population data. http://www.dmh.ca.gov/Statistics_and_Data_Analysis/RetentionPenetrationData.asp Please refer to the following report for further information about the Penetration Rate and its use: Mental Health Services Act Evaluation: Compiling Community Services and Supports (CSS) Data to Produce All Priority Indicators; Contract Deliverable 2F, Phase II http://www.mhsoac.ca.gov/Evaluations/docs/CompilingCSSDataToProducePriorityIndicators_2FPhase2_121812.pdf Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page xx Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets See pages 42 – 45. Cost Offsets can be developed only for counties that submit data to the State Department of Mental Health’s Full Service Partnership (FSP) Data Collection and Reporting System (DCR). All of the variables used in the FSP Cost Offset analysis are contained in the DCR. UCLA does not have access to non-DCR data from counties. 29 Population density was created for each county using county population and square miles of the county. The population of each county was taken from the following archival dataset: http://www.census.gov/popest/research/eval-estimates/eval-est2010.html Population Estimates, 2010, U.S. Census Bureau, Population Division. The square miles of each county was taken from the following archival dataset: http://quickfacts.census.gov/qfd/states/06000.html U.S. Census Bureau State and County Quick Facts. The areas analyzed for savings are very similar to those analyzed in the evaluation of AB 2034 efforts, which included inpatient psychiatric hospitalization and incarceration. Emergency room use was also evaluated but was limited to psychiatric rather than physical health. California Department of Mental Health (2007). (unpublished) Report to the Legislature on the effectiveness of integrated services for homeless adults with serious mental illness. Sacramento, CA: Author. 30 Percentage Insured - 2003, 2005, 2007, and 2009: California Health Interview Survey: http://www.chis.ucla.edu/ The areas analyzed for savings are very similar to those analyzed in the evaluation of AB 2034 efforts, which included inpatient psychiatric hospitalization and incarceration. Emergency room use was also evaluated but was limited to psychiatric rather than physical health. California Department of Mental Health (2007). (unpublished) Report to the Legislature on the effectiveness of integrated services for homeless adults with serious mental illness. Sacramento, CA: Author. 31 Poverty Rate: Table 1: 2009 Poverty and Median Income Estimates – Counties (released in December 2010); Source: U.S. Census Bureau, Small Area Estimates Branch http://www.census.gov/did/www/saipe/data/statecounty/data/2009.html 32 Unemployment - California Unemployment Rate (Average – Not Seasonally Adjusted) http://www.labormarketinfo.edd.ca.gov/?pageid=164 The California Employment Development Department (CA EDD) defines “Unemployment Rate” as the number of unemployed divided by the labor force then multiplied by 100 (http://www.labormarketinfo.edd.ca.gov/?pageid=1006). For sake of consistency in data presentation, UCLA calculated unemployment rates using the same method as CA EDD. 33 The foreclosure rate is defined as the number of foreclosed properties as a percent of households. HousingLink (2007). Fixing the foreclosure system: The trouble with foreclosure data. Retrieved August 23, 2011, from http://www.minneapolisfed.org/news_events/events/community/100407/foreclosuredata_obrien.pdf California Number of Foreclosures (Annual) were obtained from Realty Trac, and then foreclosure rates calculated using the methodology described above. 34 In order to create a county-level variable, the percentage of the FSP population in each county that is Caucasian was calculated. Individual- level data could not be entered into the model analyzing county-level data. For gender, the percentage of the FSP population that was male was calculated. 35 However, when the results are depicted graphically (see Exhibit IV.3), most counties tend to cluster in the center of the distribution (mid- range of expenditures, serving a population that ranges from 30 to 50% male). Therefore, the data display does not tell a clear story, and this result is inconclusive (by way of comparison, examine Exhibits IV.1 and IV.2, in which a clearer relationship can be drawn between CYF and TAY daily expenditures and the proportion of white/Caucasians served). 36 Please refer to the report for a complete discussion of cost offsets: Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Emotional Disturbance and Adults and Older Adults with Severe Mental Illness: http://mhsoac.ca.gov/Meetings/docs/Meetings/2012/Nov/OAC_111512_Tab4_MHSA_CostOffset_Report_FSP.pdf 37 Small counties have been pooled for the purpose of summarizing the data in Tables 10 – 13, and in Appendix H. For Tables 10 – 13, small county data was pooled as a means of dealing with skew (as opposed to transformation, which would not be appropriate for purpose of display in Tables 10 - 13), based upon Evaluation Advisory Group recommendation. For Appendix H, small county data was pooled for purpose of display based upon the recommendation of the Evaluation Advisory Group. This recommendation was based upon the lower number of FSPs served in smaller counties, and what would amount to an unfair comparison if aligned in a table containing larger counties. Pooling of small counties aggregates the small county data, allowing for a fairer comparison to their larger counterparts. 38 See Appendix H for a display of the data shown in this table, by county. 39 See End Notes 36 and 37. 40 Ibid. 41 Ibid. 42 Ibid. 43 Ibid. 44 Ibid. 45 Gilmer, T.P.; Stefancic, A.; Ettner, S.L.; Manning, W.G.; & Tsemberis, S. (2010). Effect of Full Service Partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness. Archives of General Psychiatry, 67, 645-652. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page xxi Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets I. Introduction Proposition 63 (2004) provides increased funding through the Mental Health Services Act (MHSA) to support mental health services for underserved and previously unserved individuals within the context of the public mental health system. Prop 63 funds are distributed to county departments of mental health to implement MHSA components. Components are: Prevention and Early Intervention (PEI); Workforce Education and Training (WET); Capital Facilities and Technological Needs (CF/TN); Innovation (INN); and Community Services and Supports (CSS), which includes the Full Service Partnership (FSP). The focus of this report is the Full Service Partnership (FSP), which is designed to serve Californians in all phases of life who experience the most severe mental health challenges because of illness or circumstance. This population has been historically underserved and has substantial opportunity for benefits from improved access and participation in quality mental health treatment and support. FSP services are a large portion of the Community Services and Supports (CSS) funding allocation from MHSA. There is a requirement that “the County shall direct the majority of its Community Services and 1 Supports funds to the Full-Service Partnership Service Category,” and that clients be served with “whatever it takes.” The remaining portions of CSS are intended to expand supportive services, such as transportation or vocational training (which are typically unfunded), crisis intervention and treatment. The Statewide Evaluation UCLA’s Center for Healthier Children, Families and Communities and EMT Associates, Inc. have been contracted by the Mental Health Services Oversight and Accountability Commission to conduct a statewide evaluation of the Mental Health Services Act. This evaluation is designed to be consistent with the intent of the Act “to ensure that all funds are expended in the most cost effective manner and services are provided in accordance with recommended best practices subject to local and state oversight to ensure accountability to taxpayers and to the public.” The UCLA/EMT Evaluation will produce deliverables in several priority areas. The purpose of this report is twofold, to specify the: 2 3 Statewide and county-specific per-person annual expenditure average for FSP Adults, Older Adults, Children and Transition-Age Youth and proportion of funding by revenue source. Financial impact of outcomes achieved in comparison with expenditures for FSP clients for at least one of the four age groups. In the context of FSP impact, this report documents how FSP service expenditures 4 are offset by savings in actual dollar amounts as a result of reductions in inpatient hospitalization days (psychiatric and physical health) and number of days incarcerated. 1 Full Service Partnership is addressed in: California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620 Full Service Partnership Service Category. Subsection (c). Note that the direct web link to CCR specific to the Mental Health Services Act requires search onsite, using the link below, http://government.westlaw.com/linkedslice/default.asp?RS=GVT1.0&VR=2.0&SP=CCR-1000&Action=Welcome 2 This report represents the combination of two Phase III contract deliverables: Phase III Deliverable 1.A – FSP Cost Report, which specifies the statewide and county-specific per-person annual cost average for FSP Adults, Older Adults, Children and Transition Age Youth and proportion of funding by revenue source; and Phase III Deliverable 1.B – FSP Cost Offset Report, the Initial written report that specifies the financial impact of outcomes achieved in comparison with expenditures for FSP clients for at least one of the four age groups. 3 The detailed report summarizing statewide findings may be found at: http://mhsoac.ca.gov/Meetings/docs/Meetings/2012/Nov/OAC_111512_Tab4_MHSA_CostOffset_Report_FSP.pdf 4 The terms cost savings and cost offsets are used interchangeably throughout this Report. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 1 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Report Overview This report, Full Service Partnerships: California’s Investment to Support Children/Transition Age Youth with Serious Emotional Disturbance, and Adults/Older Adults with Severe Mental Illness contains five chapters. A brief synopsis of each chapter follows. Chapter I – Introduction - provides a brief introduction to the report and a short orientation for the reader to the contents of each chapter. Chapter II, Involvement of Key Stakeholders, describes the process for obtaining input from expert evaluation advisors and people with lived experience, and the impetus for embarking on a process of extracting information about FSP services from CSS Plans and Updates, and subsequently confirming accuracy with the counties in order to provide context for by-county findings. A Description of Full Service Partnership Services is provided in Chapter III. The process of conducting a systematic service assessment using each county’s CSS Plan, Annual Updates, and other FSP-related documents submitted by counties/municipalities is discussed. Findings are summarized in tables, illustrating the types of FSP services provided, and the number and percentage of counties offering specific services and strategies to each age group. Expenditures on Full Service Partnership Programs are presented in Chapter IV. In plain language – this chapter contains FSP expenditures per person by age group. There is a brief discussion of the methodology used to produce FSP expenditures per person, including the elements that went into compiling FSP expenditures. The calculation for participant service years is also presented. The statewide per-person annual expenditure average by age group and the range across counties (from low to high) is shown in a table. In this chapter, findings from correlational analysis examining the potential relationship between evidence-based practices, population density, penetration rate (the proportion of people with mental illness served, compared to the population in need), and other factors related to FSP expenditures across counties are presented. Potential reasons for variation between counties are explored and discussed. Chapter V focuses on Cost Offsets for Full Service Partnership Programs. In this chapter, findings from outcome analysis of psychiatric services, physical health services and criminal justice involvement are presented that illustrate how the savings due to reduction in the number of days help pay for FSP services. The range in costs offset across counties (from low to high) is shown in a table. In this chapter, findings from correlational analysis examining the potential relationship to factors related to FSP cost offsets across counties are presented, and potential reasons for variation between counties are explored and discussed. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 2 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets II. Involvement of Key Stakeholders The Expanded Statewide Evaluation of the Mental Health Services Act specifies that the evaluation team: Establish and maintain stakeholder engagement in the evaluation that is representative of a wide scope of expertise. Engagement will include: A process for input from individuals living with mental illness, family members/personal caregivers and representatives of culturally diverse unserved and underserved groups of all ages, and A process for input from researchers, data analysts and programmers who are responsible for local data evaluation efforts. The focus of this chapter is to describe the process and contribution of engagement of stakeholders through seven key strategies: 1. Presentations to client and family groups/organizations representing unserved/underserved groups 2. Key stakeholder interviews with individuals representing client/family groups and organizations representing unserved/underserved groups 3. Presentations to associations/service provider agencies 4. Key stakeholder interviews with individuals representing associations/service provider agencies 5. Formation of an Evaluation Advisory Group 6. Key stakeholder interviews with peer advocates and parent partners 7. Product review/feedback 1. Presentations to Client & Family Groups/Organizations Representing Unserved/ Underserved Groups Outreach to client and family groups and organizations representing unserved and underserved groups was 5 conducted early in the evaluation process. An offer was made to stakeholder groups for presentation about the 6 Statewide Evaluation of the Mental Health Services Act in person, through conference calls or through webinars. A total of six (6) presentations were made during the spring/summer of 2011, during which feedback on the FSP Costs and Cost Offsets studies was actively sought. 7 With respect to the FSP Costs and Cost Offsets studies, the following themes emerged: 8 Client and family groups wanted to review the draft report and needed adequate time to do so: o Reviewers want to know the disposition of their review comments (e.g., were they used in producing the Final Report, and if not, why not?). An emphasis on recovery and resilience is sorely needed: 5 Late March-July 2011. 6 The study as a whole was presented and feedback sought with the following considerations: a) reduce stakeholder burden (to avoid returning for every deliverable and thereby requiring multiple presentations/feedback sessions), b) budgetary constraints. 7 See Appendix F for a list of organizations. 8 Commitment was made by the Cost Project Director Dr. Elizabeth Harris to each group of stakeholders that they would be sent a copy of the draft report for review and input. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 3 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets o Most of the data collected through the statewide Department of Mental Health system (the Data Collection and Reporting System, known as the DCR) are consequence-focused. In lay terms, most of what is collected about FSP clients is negative (e.g., incarceration, hospitalization). o Clients and families would like to see positive outcomes documented and somehow tied to 9 savings to the system. A key stakeholder group representing underserved and unserved individuals was very concerned that: Communities of color are not served in proportion to their actual numbers by the Full Service Partnership program. The degree to which communities of color are being served by Full Service Partnerships merits investigation, and is a key question to be addressed in a separate MHSA Statewide Evaluation deliverable. 10 2. Key Stakeholder Interviews with Individuals Representing Client & Family Groups/ Organizations Representing Unserved/Underserved Groups Stakeholder groups were contacted and offered participation in a presentation about the Statewide Evaluation of the MHSA, with an opportunity for comment and recommendation. The evaluation team met with four (4) organizations that requested in-person meetings to gain a better understanding of the study. Two agencies for Older Adults opted not to participate in presentations but made the following input: The needs of Older Adults are not addressed by every county: o A cost-offset study, therefore, may incorrectly assume that Older Adults do not have positive outcomes, when the real problem is that there are not programs under FSP in place to a) recruit 11 them and b) to specifically address their needs. o Among counties that do address the needs of Older Adults through Full Service Partnerships, some are implementing evidence-based practices (e.g., IMPACT). However, IMPACT is also being implemented by some counties under the Prevention and Early Intervention component. 12 Indeed, there are a number of evidence-based services being implemented for Older Adults under Early Intervention – which, in combination with FSP services for Older Adults, potentially provide a more robust service system. 13 Fragmentation of funding even under MHSA may make it difficult to determine the true cost offsets for Older Adults – which would be enhanced if individuals in need of early intervention participated in the same data collection and reporting system as Older Adult FSPs. The evaluation team took these concerns into consideration when conducting analyses of FSP expenditures and cost offsets by age group, as the calculation of numbers served was critical to determining expenditure per client. 9 Examples include measuring indicators of recovery, and quality adjusted life years (QALYs). 10 Phase II Deliverable 2.E – Priority Indicator Report - Mental Health Services Act Evaluation: Compiling Community Services and Supports (CSS) Data to Produce All Priority Indicators; Contract Deliverable 2F, Phase II http://www.mhsoac.ca.gov/Evaluations/docs/CompilingCSSDataToProducePriorityIndicators_2FPhase2_121812.pdf 11 A thorough, systematic review of CSS Plans was conducted expressly for the purpose of identifying services for Older Adults, using a structured review tool, by one interviewee. She has given her permission to make the results available, on request. 12 Specifically, under Early Intervention. 13 UCLA is currently conducting a statewide evaluation of PEI efforts – reports to be released in late 2013. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 4 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets In addition, see the discussion in this chapter under the Evaluation Advisory Group for the process developed for documenting and summarizing FSP services and strategies. The potential positive impact of evidence-based practices on both expenditures and cost offsets should not be under-estimated. The following assumptions may be tested: Implementing an evidence-based best practice may be more expensive because of additional staff training and ongoing supervision requirements (expenditures), and Implementing a proven practice that has previously shown demonstrable outcomes is likely to produce the same positive outcomes with FSP participants (cost offsets). See Chapters IV (expenditures) and V (offsets) for the results of analyses run to test these hypotheses. 3. Presentations to Associations/Service Provider Agencies Outreach to service provider agencies and community mental health associations/agencies was also conducted 14 early in the Phase III evaluation. A total of six (6) presentations were made during the spring/summer of 2011, 15 during which feedback on the FSP Expenditures and Cost Offsets studies was actively sought. This was the area 16 that generated the most interest and enthusiasm among community mental health associations. With respect to the FSP Expenditures and Cost Offsets studies, the following themes emerged: Service provider agencies/community mental health associations were interested in reviewing the draft 17 report. County contractors (e.g., community mental health providers) may provide MHSA services in a more cost- effective manner than the county. This hypothesis should be tested. The latter concern has clear implications for conduct of the expenditure and cost-offset analyses. Accordingly, feasibility testing is discussed in the following section. 4. Interviews with Representatives from Associations/Service Provider Agencies When the initial offer was extended to stakeholder groups for a presentation about the Statewide Evaluation of the MHSA, seven (7) organizations instead opted to meet in person or via conference call to gain a better understanding of the study. 18 The California Mental Health Planning Council, which recommended the original MHSA performance indicators, was one. The focus of its meeting was on Phase II Deliverable 2 (Statewide and County Indicator Report). 14 Late March-July 2011. 15 See the appendix for a list of organizations. 16 MHSA coordinators were interested in the Statewide Evaluation as a whole. The main theme was informing them well in advance of any expectations involving data collection. 17 Commitment was made by Dr. Harris to each group of stakeholders that they would be sent a copy of the draft report for review and input. 18 The plan was that interviewees would report items of interest back to their constituency, given the busy agendas that most association meetings entailed. However, a subsequent presentation was scheduled for the California Mental Health Planning Council, following the initial interview. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 5 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets The remaining organizational representatives were interested in the FSP Expenditures and Cost Offsets Report. The themes that emerged during the interviews echoed those discovered during presentations made to agencies/associations. In the summer of 2011, the only available data source was the Revenue and Expenditure Reports. A link to the worksheet provided by the Department of Mental Health for documenting FSP expenditures by program is provided in Appendix E (Revenue and Expenditure Reports). The worksheet breaks out expenditures under FSP into county and contractor. Based on this initial information, we determined that the question posed by associations and service provider agencies merited feasibility testing: Do the available data support our ability to answer the question, “Do county contractors (e.g., community mental health providers) provide MHSA services in a more cost-effective manner than the county?” We laid out several questions to be answered during our exploratory process: 1. Are contractors identified by a unique identification number in the Revenue and Expenditure Report? a. If yes, can this be tracked to individual client (services received) in the DCR? 2. Are contractors identified by name in the Revenue and Expenditure Report? a. If yes, can this be tracked to individual client (services received) in the DCR? The answers to #1 and #2 were no. In addition, we learned that although individual client service records in the DCR may specify the FSP service structure each person participated in, the FSP services may have been implemented by any one of a number of contractors as well as the county itself. The DCR was not designed to capture detailed service-exposure level data. The next step was to examine County Cost Reports, with the goal of answering the following questions: 1. Can FSP expenditures be disentangled out of the larger MHSA costs contained in the Cost Report? a. If yes, can individual contractor FSP billing be traced through the Cost Report (thereby bypassing the Revenue and Expenditure Reports altogether)? After an exhaustive review of the Cost Report worksheets and consultation with a county fiscal expert, 19 the answers were determined to be no. In summary, we learned the following: Individual FSP client data in the DCR contains the general name of the FSP service structure an individual person participated in, but not the individual contractor that delivered the services nor the number of contacts, amount of time of each contact, etc. Individual contractors are not identified in any systematic way in the Revenue and Expenditure Report (RER). There is no way to link RER expenditure data by contractor to either the DCR or the Cost Report. Counties would need to turn over individual-level cost data to UCLA in order to answer the question as to whether contractors deliver FSP services in a more efficient manner compared with the county. We determined that requesting this level of participation from counties is not feasible for the following reasons: Burden on county mental health departments 19 The county fiscal expert consulted completes the Cost Report worksheets annually, in addition to the Revenue and Expenditure Report. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 6 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Confidentiality concerns Budget/time constraints In sum, MHSOAC may determine that the question, “Do county contractors (e.g., community mental health providers) provide MHSA services in a more cost-effective manner than the county?” posed by community mental health associations/service provider agencies merits investigation and may develop a Request for Proposal in order to thoroughly study the issue, keeping in mind the data requirements outlined above. 5. Evaluation Advisory Group The Evaluation Advisory Group (see Appendix A) explicitly advises on FSP expenditures and cost offsets. It is composed of nationally recognized evaluators and evaluation and fiscal staff from county mental health departments. The group initially convened for an all-day meeting on November 3, 2011, in Anaheim. A follow-up meeting was held on February 6, 2012, in Encino. Each participant received a binder with PowerPoint slides that organized the meeting presentations and discussion, and backup materials for reference. The meeting produced two kinds of decisions: 1. Recommended actions. After presentation of a required step in the expenditure estimation process and a recommended action or alternatives, the group offered comment and deliberated. If consensus was reached, a recommendation for a preferred action was made. When consensus was not reached because of a need for further assessment, actions were recommended contingent on this assessment. Criteria for a final decision were typically identified. 2. Recommendations for further information from counties. In some instances it was necessary to get clarification on county data, fill gaps where information was missing in a county or gain clarification on critical points of information. The Advisory Group determined that it was appropriate to contact counties through e-mail to ask for clarifications or information specific to their county, as long as inquiries were brief and focused. When appropriate, the Advisory Group recommended queries to be made to selected counties. These Internet queries formed the basis of a web survey that was developed for county participation. Evaluation Advisory Group input in the area of expenditure and cost-offset methodology is best understood in the context of chapters devoted to these topics. Refer directly to Chapters III and IV for further discussion. Full Service Partnership Services Description For the purpose of this report and recognizing the need to be responsive to key stakeholder feedback, the UCLA/EMT team faced an immediate need to systematically categorize services across counties/municipalities in order to subsequently link specific services to specific age groups. This is important for the following reasons: FSP expenditures and cost offsets vary by county and age group. One reason may be the depth and breadth of services offered under the Full Service Partnership Program. A report about FSP expenditures and cost offsets in the absence of information about FSP services and activities by age group is to present the proverbial black box. In addition, review of the Phase II Deliverable 1 MHSA Cost Report Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 7 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets by county department of mental health stakeholders elicited feedback recommending description of Full Service Partnership programs, in order to provide the appropriate context within which to interpret findings. Therefore, the Evaluation Advisory Group recommended documentation of FSP services by county and age group as an important analysis. With the primary goal in mind of developing a standardized system of describing planned FSP services, the Community Services and Supports component section of the Three-Year Program and Expenditure Plan 20 (for the purpose of this report, we will refer to the part of the plan that addresses Community Services and Supports as the CSS Plan) and the attendant updates (Annual Updates through FY 10-11) served as the basis for the initial FSP review and summary conducted by UCLA. The FSP Service Assessment for each county/municipality was conducted using a systematic review and summary tool developed by a consultant formerly employed with a large county department of mental health and directly involved in the evaluation of that county’s MHSA program. The focus of the tool was straightforward – with instructions to trained reviewers to indicate whether planned services were present or absent in the CSS Plan and/or Annual Updates. The rating of “present” or “absent” avoided any judgment about quality, adequacy, etc., as such judgments are inappropriate absent on-site observation. The strategy of document review and summary was selected following discussion with the FSP Evaluation Advisory 21 Group, due to budget limitations and concerns about county/municipal burden inherent in a site visit/on-site service observation. The draft FSP Service Summary tool was reviewed at a FSP Evaluation Advisory Group meeting, and refined following that meeting. Following the FSP Service Summary, counties/municipalities had the opportunity to review their individualized FSP Services Assessment, and to provide supplementary documentation for consideration in the event that critical services were not documented in the CSS Plan or Annual Updates. For example, one county submitted its FSP Implementation Manual for inclusion in its FSP Service Summary. When supplementary documentation was provided by a county or municipality, its specific, individualized FSP Service Summary was updated to reflect new information. The FSP Service Summary includes documentation of the source material, for county/municipal reference. We have reviewed every county’s Community Services and Supports Plan and Annual Updates in order to generate 22 a county-specific FSP Service Summary. The FSP Service Summary indicates whether a planned service/activity was present or absent for each age group. The FSP Service Summary tool was first developed by an expert consultant and pilot tested on one county. The tool was then reviewed by the Evaluation Advisory Group. 23 Revisions were made to the tool based on feedback from the advisory group. 20 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 3. General Requirements, 3310. The Three-Year Program and Expenditure Plan. Subsection (b) (1). 21 See Appendix A for a list of Evaluation Advisory Group members. 22 The decision was made to use available data (rather than conduct site visits to each county) in order to avoid burden to the counties and due to budgetary considerations. 23 Our consultant had worked as a Full Service Partnership Coordinator for a large county. The county reviewed was the one she had worked for, with its permission. Counties were provided the opportunity to provide additional documentary evidence because services may have changed following plan submission or a service may have inadvertently been left out of the plan – in short, the Evaluation Advisory Group noted that the Plans and Updates were not designed to capture everything offered through the Full Service Partnership, and therefore the opportunity to augment with additional data must be offered to counties. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 8 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets FSP Service Summaries were sent back to each county, along with the source location (basis for the present/absent rating). 24 Counties were provided the opportunity for review/feedback, which included submission of documentary evidence to support FSP activities/practices in place. 25 County feedback was incorporated, and the FSP Assessments updated accordingly. However, due to the length of this report, and the importance of the topic as it relates to expenditures (and potentially to cost offsets), we propose that a summary of FSP Services and the potential impact on FSP Expenditures and Cost Offsets be explored in a stand-alone report. 6. Interviews with Peer Advocates & Parent Partners Following the series of presentations and interviews, the MHSA Statewide Evaluation team launched a participatory evaluation (Phase III Deliverable 2). In order to avoid burden on clients and families (and not work at cross-purposes with the participatory evaluation), the Phase III Deliverable 1 process focused on methodology and input from the Evaluation Advisory Group during the period of intensive data collection for the participatory evaluation. By June 2012, the participatory evaluation survey data collection period was winding down. A brief presentation was made to the Participatory Evaluation Consumer Advisory Board via conference call on June 5, 2012. The request was simple: How can we learn more about the positive ways that FSP clients and families are contributing to their care, as they progress in their recovery (i.e., offsetting costs)? We chose an exploratory approach for a number of reasons: 1. The Expenditures and Cost Offsets deliverable had ample opportunities for review and feedback from all stakeholder groups, throughout all phases of development. 2. Clients and families clearly expressed the need (this speaks to the type of data currently collected 26 under the DCR) to focus on positive outcomes. 3. Clients and families are in the best position to inform us about what to look for in terms of potential offset areas. 4. Budget limitations and time constraints due to the nature of the deliverable and contract prevented us from launching a second participatory evaluation in which primary (new) data collection from clients and families could be the focus. Therefore, the parameters of an exploratory approach required that no more than nine (9) peer advocates/parent partners be interviewed, and that one general question be posed (What are some of the ways you have seen people contribute to their care as they progress through recovery?), to be answered in no more than 15 minutes. A $25 gift certificate would be provided in appreciation for participation in the telephone interview. Peer advocates 24 For example, the page number in the original CSS Plan. We provided the source location to make it easier for counties to follow the logic for our ratings of whether a given service (e.g., wraparound) was present or absent. 25 One county requested a site visit in order to update its FSP Assessment. The FSP Assessment matrix accompanied the site visitor and was updated following the visit based on qualitative survey results (interview data with FSP staff). 26 Previous research by an Evaluation Advisory Group member on a subset of counties (representing the majority of the state’s population) using DCR data revealed that there is little change in employment and education outcomes, at least in the manner in which they are currently collected under the DCR paradigm. Therefore, it did not seem a worthwhile use of our resources to reinvent this particular wheel. There is no reason to expect that we would have found different results. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 9 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets and parent partners were deemed excellent sources of information, given both their lived experience and the numbers of individuals and families mentored through the Full Service Partnership program. Many wonderful examples of success emerged during the interviews, including a budding entrepreneur who had formerly been homeless. However, an unanticipated theme surfaced across the interviews. The potential for cost offsets to the system is great, but it is not being documented due to deficits in the DCR (see the graphic below): Peer networks (informal and formal): A recurring theme was the power of peers. Connection to others with lived experience was cited as the reason individuals: o Became engaged in mental health services (where previous efforts had failed) o Were no longer homeless (able to maintain independent living) o Could “step down” in service intensity (presumably resulting in savings of county staff time, or opening a slot for a new client) o Stayed out of the hospital (thanks to informal intervention by peers) o Transported their SED children to enrichment activities (thanks to peer carpooling) These were but a few examples cited by the peers (employed by county mental health departments and county contractors). The Key Event Tracking Form within the DCR requests that FSP clients be queried about time spent in volunteer activities. It fails to ask what volunteer activity they are engaged in. Therefore, time spent by FSP clients acting as informal peers/mentors for others is not documented. Peer advocates indicated that many FSP clients do not engage in paid employment during their first year of recovery. Nonetheless, the time spent volunteering as a peer advocate provides a critical service on two fronts: An informal peer network is established within the county, providing a needed support system. Public mental health system expenditures presumably are offset by the informal (and formal) peer support systems. Time spent working in a formal peer support system is likewise not documented. The Key Event Tracking Form within the DCR requests that FSP clients be queried about time spent employed. It fails to ask about the nature of the employment the FSP clients are engaged in. We recommend that the Mental Health Services Oversight and Accountability Commission consider funding a participatory evaluation to formally study the positive impact of peer networks. Such a study would provide a necessary balance to the preponderance of consequence-focused data currently collected through the state’s DCR system. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 10 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Exhibit II.1 Full Service Partnership Program – Hypothesized Relationship between Peer Networks and Cost Offsets (Potential ways that Reduced peers provide support reliance on staff – not an exhaustive list): Peers make positive connections with each other. Informal & Greater Formal Peer Clubhouse or Support independence Wellness Center Networks Positive outlook fostered by seeing success stories on Reduced weekly basis. program costs Modeling by peer advocates and parent partners. Participatory Evaluation Possibilities (this is not an exhaustive list): Determine ways in which peers provide support; assess and document cost of peer advocate and parent partner time; determine areas of recovery to be studied for potential offsets Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 11 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 7. Involvement of Key Stakeholders: Summary In all, 23 presentations, interviews and conference calls were held with key stakeholders representing clients and families, service providers and community mental health associations from the end of March through July 2011. An Evaluation Advisory Group was established, representing nationally recognized experts in cost evaluation and county department of mental health evaluators and fiscal staff. The group held two formal meetings and continues to deliberate via e-mail. Peer advocates and parent partners were interviewed in order to gain the perspective of individuals with lived experience on potential offsets that FSP participants contribute as they progress in recovery. Their input revealed a remarkable and unmeasured resource represented by peer networks. A recommendation was advanced to formally study the potential cost offset impact of peer networks on the mental health system in the statewide 27 report on FSP Expenditures and Cost Offsets. 27 http://mhsoac.ca.gov/Meetings/docs/Meetings/2012/Nov/OAC_111512_Tab4_MHSA_CostOffset_Report_FSP.pdf Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 12 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets III. Description of Full Service Partnership Programs Documenting in narrative form the essence of what constitutes a Full Service Partnership program has been codified in: 28 California Welfare and Institutions Code (Part 4.5 of 5890) 29 California Code of Regulations (Title 9, Chapter 14) Each county documented their Full Service Partnership plan in the Community Services and Supports component section of the Three-Year Program and Expenditure Plan. 30 In response, each county/municipality embarked on a process of consulting with key stakeholders within the community and conducted needs assessments in order to determine priority services, strategies and populations. The process was primary, and no artificial time limit was imposed. The result was that the planning in some settings ranged from 9 to 12 months in order to ensure that all constituents were adequately “represented at the table.” The resulting findings and recommendations were compiled into each county’s/municipality’s Community Services and Supports Plan, and submitted to the Department of Mental Health for review and approval. For the purpose of this report, the UCLA team faced an immediate need to systematically categorize services across counties/municipalities in order to subsequently link specific services to specific age groups (and to eventually arrive at a cost per FSP program by age group). With the primary goal in mind of developing a standardized system of describing planned FSP services, the Community Services and Supports Plan (CSS Plan) and the attendant updates (Annual Updates through FY 10-11) served as the basis for the initial FSP review and summary conducted by UCLA. The FSP Service Assessment for each county/municipality was conducted using a systematic review and summary tool developed by a consultant formerly employed with a large California county Department of Mental Health consultant, and directly involved in the evaluation of that county’s MHSA program. The focus of the tool was straightforward – with instructions to trained reviewers to indicate whether planned services were present or absent in the CSS Plan and/or Annual Updates. The rating of “present” or “absent” avoided any judgment about quality, adequacy, etc., as such judgments are inappropriate absent onsite observation. The strategy of document review and summary was selected after discussion with the FSP Cost Evaluation Advisory 31 Board, due to budget limitations and concerns about county/municipal burden inherent in a site visit/onsite service observation. The draft FSP Service Assessment tool was reviewed at a FSP Cost Evaluation Advisory Board meeting, and refined after that meeting. After the FSP Service Assessment, counties/municipalities had the opportunity to review their individualized FSP Services Assessment, and to provide supplementary documentation for consideration in the event that critical 28 Welfare and Institutions Code (WIC), Division 5. Community Mental Health Services, Part 4.5. Mental Health Services Fund 5890 Parts 3 and 4. Note that the direct web link to WIC specific to the Mental Health Services Act requires search onsite, using the link below. The direct link to each code cannot be reproduced, and will not lead directly to the specific WIC. The only way to retrieve each WIC is to search the site, http://leginfo.legislature.ca.gov/faces/codes.xhtml Certified as current (January 18, 2013). 29 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620. Full Service Partnership Service Category. 30 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 3. General Requirements, 3310. The Three-Year Program and Expenditure Plan. Subsection (b) (1). 31 See Appendix A for a list of FSP Cost Evaluation Advisory Board Members. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 13 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets services were not documented in the CSS Plan or Annual Updates. For example, one county submitted its FSP Implementation Manual for inclusion in its FSP Services Assessment. When supplementary documentation was provided by a county or municipality, its specific, individualized FSP Service Assessment was updated to reflect new information. The FSP Assessment Tool includes documentation of the source material, for county/municipal reference. The manner in which FSP services are conceptualized is described in the following section, along with brief descriptions of the strategies identified in the CSS Plans and Annual Updates. a. Full Service Partnership Services Full Service Partnership services (FSP) are most succinctly described as: A ‘Whatever It Takes’ approach means to find the methods and means to engage an individual, determine their needs, and create collaborative services and support to meet those needs. 32 (p. 13) This brief description encapsulates all of the critical elements of the FSP “service package” Outreach/engagement, Support services (broadly defined), and Housing. The specific strategies planned by each county and municipality vary, dependent upon the: needs of constituents identified during the extensive planning process that took place as a condition of, and prior to MHSA funding for FSP, and plan review, input and approval process. Descriptions of FSP services planned for implementation by counties/municipalities in FY 06-07 through FY 09-10 are provided in the following report sections, along with a summary of the number and percentage of counties/municipalities that planned to implement each practice. 1. Outreach and Engagement The priority for FSP is to identify populations currently receiving little or no service, and conduct outreach to those populations: “Outreach and Engagement Service Category” means the service category of the Community Services and Supports component of the Three-Year Program and Expenditure Plan under which the County may fund activities to reach, identify, and engage unserved individuals and 33 communities in the mental health system and reduce disparities identified by the County. 32 California Institute for Mental Health (2010). Full Service Partnership Implementation Tool Kits. Sacramento: Author. 33 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.240. Outreach and Engagement Service Category. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 14 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets In addition, to engage with the intent of providing service: “Underserved” means clients of any age who have been diagnosed with a serious mental illness and/or serious emotional disturbance and are receiving some services, but are not provided the necessary or appropriate opportunities to support their recovery, wellness, and/or resilience. When appropriate, it includes clients whose family members are not receiving sufficient services to support the client’s recovery, wellness, and/or resilience. These clients include, but are not limited to: - those who are so poorly served that they are at risk of homelessness, institutionalization, incarceration, out‐of‐home placement or other serious consequences; - members of ethnic/racial, cultural, and linguistic populations that do not have access to mental health programs due to barriers such as poor identification of their mental health needs, poor engagement and outreach, limited language access, and lack of culturally competent services; and - those in rural areas, Native American Rancherias and/or reservations who are not receiving 34 sufficient services. “Unserved” means those individuals who may have serious mental illness and/or serious emotional disturbance and are not receiving mental health services. Individuals who may have had only emergency or crisis‐oriented contacts and/or services from the County may also be 35 considered unserved. 2. Assessment and Planning A key characteristic of the MHSA requirements for FSP Planning and Assessment is the proactive nature of the strategies. The pre-existing standard of care statewide had been criticized as reactive and crisis-oriented. 36 The thoughtful assessment and planning process under the MHSA FSP service model involves defining the target population and ensuring that clients are engaged in services. In short, there is an emphasis on identifying potential client who will likely benefit from FSP services, rather than filling patient quotas. Clear Eligibility Criteria The following eligibility criteria are taken directly from MHSA statutes: Children and adolescents identified as Seriously Emotionally Disturbed (SED) are eligible for FSPs if they meet the criteria set forth in Welfare and Institutions Code section 5600.3, subdivision (a). Adults and Older Adults identified 34 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.300. Underserved. 35 California Code of Regulation (Barclays Official), Title 9. Rehabilitative and Developmental Services, Division 1. Department of Mental Health, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.310. Unserved. 36 A hallmark of Prop 63 was the ability to take the success demonstrated through AB 34 and SB 2034 programs statewide. Prior to the passage of Prop 63, SB 2034 had expanded to only 30 counties. http://www.pendari.com/DMH/Books/MHSA_and_Transformation/files/mhsa_and_transformation.pdf Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 15 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets to have a serious mental disorder are eligible for FSPs if they meet the criteria set forth in subdivision (b) of section 37 5600.3. A. SED Children who fall into at least ONE of the following groups: GROUP 1: As a result of the mental disorder, the child has substantial impairment in at least two of these areas: 1. Self–care 2. School functioning 3. Family relationships 4. Ability to function in the community, and Either of the following occur: 1. The child is at risk of or has already been removed from the home 2. The mental disorder and impairments have been present for more than six months or are likely to continue for more than one year without treatment GROUP 2 – The child displays at least ONE of the following features: Psychotic features Risk of suicide Risk of violence due to a mental disorder GROUP 3 – The child meets special education eligibility requirements under Chapter 26.5 of the Government Code. B. SED Transition-Age Youth (youth 16 years to 25 years old) who meet ALL of the following: They fall into at least one of the groups in (A) above. They are unserved or underserved and in one of the following situations: 1. Homeless or at risk of being homeless 2. Aging out of the child and youth mental health system 3. Aging out of the child welfare system 4. Aging out of the juvenile justice system 5. Involved in the criminal justice system 6. At risk of involuntary hospitalization or institutionalization, or 7. Have experienced a first episode of serious mental illness C. SMI Adults who meet ALL of the following. Their mental disorder results in substantial functional impairments or symptoms, or they have a psychiatric history that shows that, without treatment, there is an imminent risk of decompensation with substantial impairments or symptoms. Due to mental functional impairment and circumstances, they are likely to become so disabled as to require public assistance, services, or entitlements, and they are in one of the following situations: 1. They are unserved and one of the following: o Homeless or at risk of becoming homeless o Involved in the criminal justice system o Frequent users of hospital or emergency room services as the primary resource for mental health treatment 2. They are underserved and at risk of one of the following: 37 California’s Welfare and Institutions Code (WIC), Division 5. Community Mental Health Services, Part 2.0, The Bronzan-McCorquodale Act Fund. 5600.3. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 16 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets o Homelessness o Involvement in the criminal justice system o Institutionalization D. SMI Older Adults (an adult 60 years or older) who meet ALL of the following: Their mental disorder results in substantial functional impairments or symptoms, or they have a psychiatric history that shows that, without treatment, there is an imminent risk of decompensation with substantial impairments or symptoms. Due to mental functional impairment and circumstances, they are likely to become so disabled as to require public assistance, services, or entitlements. AND They are in one of the following situations: 1. They are unserved and one of the following: o Experiencing a reduction in personal and/or community functioning o Homeless o At risk of becoming homeless o At risk of becoming institutionalized o At risk of out-of-home care o At risk of becoming frequent users of hospital or emergency room services as the primary resource for mental health treatment 2. They are underserved and at risk of one of the following: o Homelessness o Institutionalization o Nursing home or out-of-home care o Frequently using hospital and/or emergency room services as their primary resource for mental health treatment o Involvement in the criminal justice system Needs Assessment A formal needs assessment, though not a requirement in statute, is recommended by the California Mental Health Directors Association (CMHDA). CMHDA defines needs assessment as a formal process using an instrument that: Has been tested and proved reliable, and is used to help consumers and staff determine what 38 services might be needed. Included in this assessment are: - The consumer’s current stage of engagement - Their current level of functional impairment - Their other medical problems or substance abuse - Their available family and community support - Their level of stress and their risk of harm (p. 1) Individual Services and Supports Plan “Individual Services and Supports Plan” means the plan developed by the client and, when appropriate, the client’s family, with the Personal Service Coordinator/Case Manager to identify the client’s goals and describe the array of services and supports necessary to advance these 38 California Mental Health Directors Association, Adult System of Care Committee. (2008, April). Recommended Guidelines for Levels of Service. http://www.cmhda.org/committees/documents/ASOC/Handouts/0806/0806_ASOC_Handouts_ASOC_LOS_policy_and_guidelines_April08_%286-25-08%29.pdf Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 17 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets goals based on the client’s needs and preferences and, when appropriate, the needs and 39 preferences of the client’s family. Service Delivery based on Needs Assessment & Individual Services and Supports Plan One goal of a transformed mental health system is to enter into partnership with clients and their families, and to provide services based on the client’s needs, rather than to try to fit the client into pre-existing service models. This necessitates up-front planning jointly with the client, accounting for individual needs and preferences. Findings: Outreach and Engagement The priority for FSP is to identify populations currently receiving little or no service, and conduct outreach to those populations. In addition, to engage currently unserved and underserved individuals with serious emotional disturbance/severe mental illness with the intent of providing service. A thoughtful assessment and planning process under the MHSA FSP service model involves defining the target population and ensuring that clients are engaged in services. Outreach and Engagement for FSPs are summarized by age group across the counties/municipalities in Table III.1. Table III.1 Number and Percent of Counties Reporting Implementation of Full Service Partnership Services – 40 Outreach and Engagement Counties: Counties: Counties: Counties: CYF TAY Adults Older Adults (N=54) (N=59) (N=59) (N=54) Service Strategy N % N % N % N % Outreach and Engagement* 47 87.0% 55 93.2% 55 93.2% 51 94.4% Outreach to Underserved and Unserved 44 81.5% 55 93.2% 55 93.2% 51 94.4% Priority to Unserved Populations 47 87.0% 52 88.1% 54 91.5% 45 83.3% Assessment and Planning 53 98.1% 59 100% 56 94.9% 53 98.1% Clear FSP Eligibility Criteria 47 87.0% 54 91.5% 47 79.7% 44 81.5% Needs Assessment 38 70.4% 46 78.0% 44 74.6% 43 79.6% Individual Services and Supports Plan (ISSP)* 40 74.1% 50 84.8% 46 78.0% 40 74.1% Service Delivery - Needs Assessment/ISSP 30 55.6% 38 64.4% 37 62.7% 29 53.7% TOTAL 53 98.1% 59 100% 59 100% 54 100% * Services/strategies in Table III.1 indicated with an asterisk (*) represent requirements under the Mental Health Services Act. The data displayed in Table III.1 support the following conclusions regarding implementation of initial Outreach and Engagement services across the state: Outreach is conducted by 81.5 to 94.4 percent of the counties, depending upon the age group. Priority to unserved populations the stated intent for 83.3 to 91.5 percent of counties, depending upon the age group. 39 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.180. Individual Services and Supports Plan. 40 See Appendix B for counties providing FSP services to each age group. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 18 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Guidelines around assessment and FSP service planning are in documented as being in place in nearly all counties. 3. Personal Service Coordinator/Case Manager Services under the Full Service Partnership include designation of a Personal Service Coordinator/Case Manager for each client, and when appropriate, the client’s family, to the single point of responsibility for that client/family. 41 The end result of the shift should be a more humane manner of interacting with clients, and a more engaged clientele. Low Caseload The County shall provide a sufficient number of Personal Service Coordinators/Case Managers to ensure that: - Availability is appropriate to the service needs of the client/family - Individualized attention is provided to the client/family 42 - Intensive services and supports are provided, as needed 24/7 Coverage The County shall ensure that a Personal Service Coordinator/Case Manager or other qualified individual known to the client/family is available to respond to the client/family 24 hours a day, 7 43 days a week to provide after-hour intervention. In the event of an emergency when a Personal Service Coordinator/Case Manager or other qualified individual known to the client/family is not available, the County shall ensure that another qualified individual is available to respond to the client/family 24 hours a day, 7 days a week to provide after-hour intervention. Small Counties may meet this requirement through the use of peers or community partners, such as community-based organizations, who are known to the client/family. A staff member (clinician or paraprofessional) known to the client/family has the advantage of an existing alliance with the client/family, knows the client/family’s history, and has access to the community and other agencies that the client/family is engaged with for services. In short, the staff member can cut through red tape and quickly assist, where others would be faced with conducting detailed assessments or making decisions about emergency hospitalization. 41 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620. Full Service Partnership Service Category. Subsection (f). 42 Ibid. 43 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620. Full Service Partnership Service Category. Subsection (i). Scroll down on the page to Subsection (i) for specific language related personal service coordinators and the 24/7 requirement. (1) and (2) underneath (i) provide further clarification. This report author was one of the few LA County DMH FFS providers on call 24/7 (prior to MHSA), and provided just such an intervention for a Medi-Cal client suffering from schizophrenia. This author (also a licensed psychologist) informed the landlord of her client’s rights under the law (eviction in the middle of the night without due notice was, of course, illegal). A more suitable (Section 8) placement was eventually found for this client. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 19 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets The requirement for 24/7 coverage by a staff person known to the client/family has, in and of itself, enormous potential for savings in terms of reducing emergency hospitalizations (a hypothesis we explore later in this report). Services in the Community versus the Clinic Meeting clients/family members in settings that they are comfortable with, instead of asking them to come to foreign places for service, should not be a revolutionary concept. Yet the traditional public mental health system, in many regards, is still built around the old concept that is prevalent in popular culture – the client coming in to the therapist’s office, with the traditional waiting room where the client checks in at the front desk (except in many public mental health clinics, there is a security guard at the front door, and the client must first pass through a metal detector before checking in). Contrast this setting to one that is more typical of social work – the professional or paraprofessional makes arrangements to meet the client/family at their home, or in a public setting comfortable to the family (e.g., community center, park). There are no armed guards, no metal detectors – the message is one of alliance, not opposition. This is not to negate the very real danger that clinicians sometimes face (e.g., the tragedy that prompted Laura’s Law). Nonetheless, the flexible nature of the FSP program enables counties/municipalities to develop appropriate outreach and engagement practices that work toward bringing in those who will benefit from FSP services, and flag those for whom a community-based intervention may not be appropriate due to staff safety and other concerns. Findings: Personal Services Coordinator/Case Manager Implementation of a Personal Services Coordinator/Case Manager when serving FSPs is summarized by age group across the counties/municipalities in Table III.2. Table III.2 Number and Percent of Counties Reporting Implementation of Full Service Partnership Services – 44 Personal Services Coordinator/Case Manager Counties: Counties: Counties: Counties: CYF TAY Adults Older Adults (N=54) (N=59) (N=59) (N=54) Service Strategy N % N % N % N % Personal Services Coordinator/Case Manager* 52 96.3% 58 98.3% 59 100% 52 96.3% Low Caseload 35 64.6% 39 66.1% 38 64.4% 35 64.6% 24/7 Coverage* 46 85.2% 54 91.5% 53 89.8% 44 81.2% Services in the Community vs. Clinic 42 77.8% 44 74.6% 41 69.5% 38 70.4% TOTAL 52 96.3% 58 98.3% 59 100% 52 96.3% * Services/strategies in Table III.2 indicated with an asterisk (*) represent requirements under the Mental Health Services Act. The findings, based upon review of county plans and updates and subsequent county review, are as follows regarding the implementation of services to FSPs according to required MHSA practices: Keeping to a low caseload appears to be the most difficult challenge for counties, regardless of age group. Only 64.6 to 66.1 percent of counties reported implementation of a reduced caseload. 24/7 coverage was documented for 81.2 to 91.5 percent of the counties. 44 See Appendix B for counties providing service to each age group. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 20 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Specific reference to services at community-based locations (as compared with a mental health clinic setting) was documented for 96.3 to 100 percent of counties, depending upon the age group. 4. General Standards In the California Code of Regulations is an articulated a set of recovery and resiliency-oriented principles to guide implementation of the Mental Health Services Act. 45 Due to the radical departure from business as usual, the General Standards were laid out and defined to a certain degree (depending upon the standard and the level of abstraction): 1. Community Collaboration 2. Cultural Competence 3. Client-Driven 4. Family-Driven 5. Wellness, Recovery, and Resilience Focused 6. Integrated Service Experiences for clients and their families The General Standards and the operational definitions as described in the California Code of Regulations are outlined below. Community Collaboration The California Code of Regulations lays out the “big picture” with respect to collaboration: “Community Collaboration” means a process by which clients and/or families receiving services, other community members, agencies, organizations, and businesses work together to share 46 information and resources in order to fulfill a shared vision and goals. Collaboration with community services refers to the mechanics of interacting with interested parties in order to 47 exchange information and share resources to support people in their recovery process. Cultural Competence The reduction of racial and cultural disparities in access to services and receipt of services is central to the MHSA vision. “Cultural Competence” means incorporating and working to achieve each of the goals listed below into all aspects of policy-making, program design, administration and service delivery. Each system and program is assessed for the strengths and weaknesses of its proficiency to 45 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 3. General Requirements, 3320. General Standards. 46 California Code of Regulation (Barclays Official), Title 9. Rehabilitative and Developmental Services, Division 1. Department of Mental Health, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.060. Community Collaboration. 47 New Freedom Commission on Mental Health (2003). Achieving the Promise: Transforming Mental Health Care in America. Executive Summary. DHHS Pub. No. SMA-03-3831. Rockville, MD. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 21 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets achieve these goals. The infrastructure of a service, program or system is transformed, and new 48 protocol and procedure are developed, as necessary, to achieve these goals. - Equal access to services of equal quality is provided, without disparities among racial/ethnic, cultural, and linguistic populations or communities. - Treatment interventions and outreach services effectively engage and retain individuals of diverse racial/ethnic, cultural, and linguistic populations. - Disparities in services are identified and measured, strategies and programs are developed and implemented, and adjustments are made to existing programs to eliminate these disparities. - An understanding of the diverse belief systems concerning mental illness, health, healing and wellness that exist among different racial/ethnic, cultural, and linguistic groups is incorporated into policy, program planning, and service delivery. - An understanding of the impact bias, racism, and other forms of discrimination have on the mental health of each individual served is incorporated into service delivery. - Services and supports utilize the strengths and forms of healing that are trained to understand and effectively address the needs and values of the particular racial/ethnic, cultural and/or linguistic population or community that they serve. - Strategies are developed and implemented to promote equal opportunities for administrators, service providers, and others involved in service delivery who share the diverse racial/ethnic, cultural and linguistic characteristics of individuals with serious mental illness/emotional disturbance in the community. Client and Family-Driven Care “Client Driven” means that the client has the primary decision-making role in identifying his/her needs, preferences and strengths and a shared decision-making role in determining the services and supports that are most effective and helpful for him/her. Client driven programs/services use clients’ input as the main factor for planning, policies, procedures, service delivery, evaluation and the definition and determination of outcomes. 49 “Family Driven” means that families of children and youth with serious emotional disturbance have a primary decision-making role in the care of their own children, including the identification of needs, preferences and strengths, and a shared decision-making role in determining the services and supports that would be most effective and helpful for their children. Family driven programs/services use the input of families as the main factor for planning, policies, procedures, service delivery, evaluation, and the definition and determination of outcomes. 50 48 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.100. Cultural Competence. 49 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.050. Client Driven. Note that the grammatical error (lack of hyphen between Client and Driven is inherent the original text – because it is quoted verbatim, it has not been corrected. 50 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.120. Family Driven. Note that the grammatical error (lack of hyphen between Family and Driven is inherent the original text – because it is quoted verbatim, it has not been corrected. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 22 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Wellness, Recovery and Resilience-Focused This concept is one of the most revolutionary and important concepts in mental health. Although recovery has long been a cherished belief in the addiction field, this mantra has been adopted on a broad scale in the field of mental 51 health within the past decade. The Federal Substance Abuse and Mental Health Services Administration recently elevated recovery to even greater prominence in its 2011–14 strategic plan. Although the previous plan (2006–11) emphasized resiliency and recovery, the current plan is unequivocal in its slogan: “Treatment is Effective. People recover.” 52 The California Code of Regulations ensures that the General Standards of Wellness, Recovery and Resilience are built into services across the Community Services spectrum: “Full Spectrum of Community Services” means the mental health and non-mental health services and supports necessary to address the needs of the client, and when appropriate the client’s family, in order to advance the client’s goals and achieve outcomes that support the client’s 53 recovery, wellness and resilience. [italics added for emphasis] Integrated Service Experience “Integrated Service Experience” means the client, and when appropriate the client’s family, accesses a full range of services provided by multiple agencies, programs and funding sources in a comprehensive and coordinated manner. 54 In order to accomplish delivery of service that is integrated, a necessity is joint planning between the various agencies involved with the client/family. In the absence of coordinated service plans, individual agencies/providers continue to interact with clients/families in a “silo” manner. Clients/families experience disjointed interactions with multiple providers, who give sometimes conflicting messages and instructions. When the client/family is the focus (as discussed above), the paradigm shifts from the convenience of the provider/agency to developing a plan of care that best meets the client’s/family’s needs. Findings: General Standards There are five General Standards imbedded in the MHSA that must be interwoven into all services (including FSP). Implementation of services to FSPs according to General Standards is summarized by age group across the counties/municipalities in Table III.3. 51 Substance Abuse and Mental Health Services Administration. (2003). Strategies for Developing Treatment Programs for People With Co- Occurring Substance Abuse and Mental Disorders. SAMHSA Publication No. 3782. Rockville, MD: SAMHSA. http://www.fccmh.org/resources/docs/Strategies.pdf 52 Substance Abuse and Mental Health Services Administration. (2011). Leading Change: A Plan for SAMHSA’s Roles and Actions 2011-2014 Executive Summary and Introduction. HHS Publication No. (SMA) 11-4629 Summary. Rockville, MD: Substance Abuse and Mental Health Services Administration. 53 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.150. Full Spectrum of Community Services. 54 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.190. Integrated Service Experience. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 23 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table III.3 Number and Percent of Counties Reporting Implementation of Full Service Partnership Services – General Standards 55 Counties: Counties: Counties: Counties: CYF TAY Adults Older Adults (N=54) (N=59) (N=59) (N=54) Service Strategy N % N % N % N % General Standards* 54 100% 59 100% 59 100% 59 100% Community Collaboration 49 90.7% 57 96.6% 47 79.7% 44 81.2% Cultural Competence 52 96.3% 58 98.3% 57 96.6% 51 94.4% Client-Driven Care 37 68.5% 46 78.0% 49 83.1% 36 66.7% Family-Driven Care 45 83.3% 44 74.6% 39 66.1% 34 63.0% Wellness, Recovery, Resilience Focused 54 100% 59 100% 59 100% 54 100% Integrated Service Experience 44 81.2% 53 89.8% 52 88.1% 45 83.3% TOTAL 54 100% 59 100% 59 100% 54 100% * Services/strategies in Table III.3 indicated with an asterisk (*) represent requirements under the Mental Health Services Act. Depending upon the principle and the age group, nearly all counties documented addressing this requirement (96.3 to 98.3 percent). 5. Outpatient Mental Health Services The California Code of Regulations states that clients, through the Full Service Partnership agreement, may have access to the Full Spectrum of Community Services necessary to attain the goals identified in the Individual 56 Services and Supports Plan (ISSP). Mental health services and supports are listed. The Welfare and Institutions Code specifies: For the majority of seriously mentally disordered adults and older adults, treatment is best provided in the client’s natural setting in the community. Treatment, case management, and community support services should be designed to prevent inappropriate removal from the 57 natural environment to more restrictive and costly placements. and 58 Enable children to remain at home with their families whenever possible. This statement implies the inclusion of outpatient services, which includes Medi-Cal services and Medi-Cal reimbursement, for those eligible for this federal cost-sharing program. 59 If Medi-Cal reimburses for a proportion 55 See Appendix B for counties providing service to each age group. 56 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620. Full Service Partnership Service Category. 57 California’s Welfare and Institutions Code (WIC), Division 5. Community Mental Health Services, Part 3.0, Adult and Older Adult Mental Health System of Care Act, 5801. 58 California’s Welfare and Institutions Code (WIC), Division 5. Community Mental Health Services, Part 4.0, The Children’s Mental Health Services Act, 5851. 59 (a) The County shall utilize Mental Health Services Act (MHSA) funds only to establish or expand mental health services and/or supports for the components specified in Section 3310(b) and for the Community Program Planning Process specified in Section 3300. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 24 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets of FSP clients, implicit is the assumption that such reimbursement may be viewed as an added benefit to the county/municipality, but Medi-Cal reimbursement should not be the driver of FSP outreach, enrollment, or service delivery. Individual and Group Therapy DMH’s billing manual for Medi-Cal mental health services describes individual and group therapy in terms of purpose, and describes the settings in which Medi-Cal will not reimburse for service. Individual and group therapy are not described per se. Rather, activities that may occur during individual and group therapy are listed (e.g., assessment, planning, therapy). 60 Medication Support In contrast to individual and group therapy, the billing manual for Medi-Cal provides a clear definition of the expected activities to be associated with Medication Support: Medication Support Services are those services that include prescribing, administering, dispensing and monitoring psychiatric medications or biologicals that are necessary to alleviate the symptoms of mental illness. Service activities may include but are not limited to evaluation of the need for medication; and collateral and plan development related to the delivery of the service and/or assessment of the patient. 61 (p. 4-13) Crisis Intervention The ability to intervene in a psychiatric emergency without the requirement to hospitalize is important to maintaining the liberty and self-determination of clients in the public mental health system. Crisis Intervention (as compared to Crisis Stabilization) provides the mechanism for doing so in an outpatient setting. Another characteristic is the brevity of intervention length (less than 24), compared to the longer time frames employed for 62 Crisis Stabilization. Case Management/Brokerage This essential service is described in the DMH billing manual: Case Management/Brokerage is a service that assists a patient to access needed medical, educational, social, pre-vocational, rehabilitative, or other community services. The service activities may include, but (b) Programs and/or services provided with MHSA funds shall: (1) Offer mental health services and/or supports to individuals/clients with serious mental illness and/or serious emotional disturbance, and when appropriate their families. (A) The Prevention and Early Intervention component is exempt from this requirement. (2) Be designed for voluntary participation. No person shall be denied access based solely on his/her voluntary or involuntary legal status. (3) Comply with the requirements in Section 3410, Non-Supplant. (c)To the extent allowed under (a) and (b) of this Section, the County may use MHSA funds to match other funding sources, such as Medi- Cal and the Healthy Families Program. The County shall not submit requests for MHSA funding solely for the purpose of increasing reimbursement for Medi-Cal or the Healthy Families Program. California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 4. Funding Provisions, 3400. Allowable Costs and Expenditures. 60 California Department of Mental Health. (2008, July). Mental Health Medi-Cal Billing Manual (Version 1.0). Sacramento: Author. 4.2.12 Mental Health Services: Title 9, Section 1810.227, p. 4-12. 61 California Department of Mental Health. (2008, July). Mental Health Medi-Cal Billing Manual (Version 1.0). Sacramento: Author. 4.2.12 Mental Health Services: Title 9, Section 1810.25, p. 4-13. 62 Ibid. 4.2.12 Mental Health Services: Title 9, Section 1840.338 & 1840.348, p. 4-13. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 25 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets are not limited to: communication, coordination, and referral; monitoring service delivery to ensure patient access to service and the service delivery system; monitoring the patient’s progress; placement 63 services; and plan development. (italics added, p. 4-12) Findings: Outpatient Mental Health Services Implementation of outpatient mental health services to FSPs is summarized by age group across the counties/municipalities in Table III.4. Table III.4 Number and Percent of Counties Reporting Implementation of Full Service Partnership Services – Outpatient Mental Health Services 64 Counties: Counties: Counties: Counties: CYF TAY Adults Older Adults (N=54) (N=59) (N=59) (N=54) Service Strategy N % N % N % N % Outpatient Mental Health Services 51 94.4% 58 98.3% 56 94.9% 50 92.6% Individual Therapy 30 55.6% 31 52.5% 30 50.9% 26 48.2% Group Therapy 27 50.0% 30 50.9% 30 50.9% 25 46.3% Medication Support 26 48.2% 35 59.3% 37 62.7% 35 64.6% Crisis Intervention 41 75.9% 44 74.6% 43 72.9% 41 75.9% Case Management 36 66.7% 53 89.8% 48 81.4% 31 57.4% TOTAL 51 94.4% 58 98.3% 56 94.9% 50 92.6% Outpatient mental health services are offered in 92.6 to 98.3 percent of the counties to FSPs, depending upon the age group served. 6. Other Supports The requirement to do “whatever it takes” for FSP clients implies a broad range of services and supports not typically associated with the traditional mental health model. Such supports include assistance in meeting daily living needs, paying for health care, and providing respite services when needed. Instrumental Needs The California Code of Regulations provides examples of the ways in which FSP programs can meet the 65 instrumental (daily living) needs of clients and their family members (including, but not limited to): Food Clothing 63 Ibid. 4.2.12 Mental Health Services: Title 9, Section 1840.249, p. 4-12. 64 See Appendix B for counties providing service to each age group. 65 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620. Full Service Partnership Service Category. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 26 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Cost of Health Care Treatment The California Institute for Mental Health recently (2010) sponsored an “Integration Forum” in which national data were presented, illustrating that the mentally ill are more likely to suffer from chronic health conditions; the average age of death is a relatively young (by today’s standards) 53 years of age. Timely access to health care therefore is critical for those served by FSPs. 66 Cost of health care treatment is specifically noted in the California Code of Regulations as a “non-mental health service and support” allowable under the Full Service Partnership. 67 Respite Services Respite services are allowable under the Full Service Partnership program for all age groups. 68 Supportive Employment/Education The range of allowable activities as described in the Community Services and Supports Plan considers the needs of clients across the age range with respect to employment and education through facilitation of placement in “supportive” settings. Supportive employment and education facilitate collaborative arrangements in which the 69 placement and partners are part of the recovery plan. Psychoeducation/ Family Education A fully informed constituency is a critical element of the Mental Health Services Act. Toward that end, Full Service Partnership strategies include education about the mental health assessment and diagnosis process, the manner in which the service plan is development, treatment options, medication and client rights with respect to medication, and other relevant information. 70 Educational/Employment Supplies Although not explicitly suggested or required, some counties proposed assisting clients and families in obtaining school and work supplies (e.g., college text books, uniforms for work). Recreational/Social Activities Providing clients and families with meaningful opportunities to interact socially with peers in a relaxed setting is consistent with a recovery-oriented model. Although not explicitly suggested or required, some counties proposed clients to be involved and engaged in the planning of recreational and social activities. Transportation A viable means to move about in the community is critical to full engagement as a citizen in a recovery-oriented treatment program. Transportation therefore becomes the linkage for clients who may not otherwise have the means to move easily and freely about, particularly in rural counties with large geographic distances, or in counties with long commute times due to heavy traffic. 66 California Institute for Mental Health (2011). Mental Health and Substance Abuse Disorder Services as Core Elements of Health Homes. Presented at the Regional Mental Health/Substance Abuse/Primary Care Integration Forum, Sacramento. 67 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620. Full Service Partnership Service Category. 68 Ibid. 69 Ibid. 70 Ibid. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 27 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Parenting Education Offering Parenting Education to family members caring for a child/youth with serious emotional disorders or, adults with serious mental illness who have children does not imply that they are poor parents in need of education. Rather, dealing with serious emotional disorders/serious mental illness can test the mettle of even the most patient and well-educated parent. Learning about parenting in a safe environment that is free from judgment represents a “value-added” service when peers can seek support from one another, as well as learn skills unique to their situation. Intimate Partner Violence Services Specialized services to address the specific needs of individuals suffering from intimate partner violence may include counseling, placement in temporary protective shelter, assistance in obtaining a restraining order, guidance on legal rights, etc. Findings: Other Supports The requirement to do “whatever it takes” for FSP clients implies a broad range of services and supports not typically associated with the traditional mental health model. Such supports include assistance in meeting daily living needs, paying for health care, and providing respite services when needed. Implementation of other support services to FSPs is summarized by age group across the counties/municipalities in Table III.5. Table III.5 Number and Percent of Counties Reporting Implementation of Full Service Partnership Services – 71 Other Supports Counties: Counties: Counties: Counties: CYF TAY Adults Older Adults (N=54) (N=59) (N=59) (N=54) Service Strategy N % N % N % N % Other Supports 48 88.9% 57 96.6% 56 94.9% 48 88.9% Instrumental Needs 29 53.7% 32 54.2% 33 55.9% 28 51.9% Cost of Health Care Treatment 11 20.4% 10 17.0% 9 15.3% 8 14.8% Respite Services 17 31.5% 15 25.4% 12 20.3% 16 29.6% Supportive Employment/Education 3 6.0% 11 18.6% 11 18.6% 8 14.8% Psychoeducation 29 53.7% 33 55.9% 33 55.9% 27 50.0% Family Education 33 61.1% 35 59.3% 32 54.2% 28 51.9% Educational/ Employment Supplies 31 57.4% 33 55.9% 30 50.9% 24 44.4% Recreational/Social Activities 23 42.6% 32 54.2% 28 47.5% 23 42.6% Transportation 34 63.0% 40 67.8% 39 66.1% 34 63.0% Parenting Education 26 48.1% 21 35.6% 14 23.7% Intimate Partner Violence Services 6 11.1% 9 15.3% 11 18.6% 11 20.4% TOTAL 48 88.9% 57 96.6% 56 94.9% 48 88.9% 71 See Appendix B for counties providing service to each age group. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 28 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Other support services are offered in 88.9 to 96.6 percent of counties, depending upon the age group served by the FSP. 7. Peer Support Services A complementary component directly related to provision of Full Service Partnership services is Workforce Education and Training – specifically, the Workforce Staffing Support Funding Category. 72 Ideally, the team consists of bilingual staff, clients, and family members who are hired to assist in addressing elimination of disparities to underserved and unserved racial/ethnic clients and family members: Deficits in cultural and/or linguistic competence Promotion of employment and career opportunities in the Public Mental Health System for clients and family members of clients Hence, although it is not an explicit requirement that counties include clients and family members be hired on as FSP team members, a common theme throughout CSS Plans was client and family employment in specific and concrete roles, leading the UCLA Team to document the critical ways in which peers and parent advocates are engaged in meaningful service in the public mental health system. Specific Positions for Peers Peer teams are staffed by consumers and family members. When appropriate, they often take on roles such as mentors, counselors, educators and advocates, etc. Such team members are valuable in providing referrals to community resources and providing general support to their peers. According to Peer Support among Inpatients in an Adult Mental Health Setting (2010), peer support is a thoughtful process that involves observing, reflecting, taking action, and evaluating outcomes. Supportive actions include helping with activities of daily living, sharing material goods, providing information and advice, sharing a social life, and offering emotional support. This leads to various positive outcomes for providers and recipients of peer 73 support, such as improved mental health outcomes and quality of life (p. 589). Peer staff members have often utilized such services in the past and, with proper training, are equipped to provide such services to other peers. Findings: Peer Supports – Specific Positions for Peers The number of counties employing peers/parent advocates, and the specific positions are summarized by age group across the counties/municipalities in Table III.6. 72 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 8. Workforce Education and Training, 3845. Workforce Staffing Support Funding Category. Scroll down to (a) (2) (C) and (3) (A), (B) and (C) 73 Bouchard, L. (2010). Peer Support among Inpatients in an Adult Mental Health Setting. Issues In Mental Health Nursing, 31(9), 589-598. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 29 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table III.6 Number and Percent of Counties Reporting Implementation of Full Service Partnership Services – Peer Support – Specific Positions for Parent Peers Counties: Counties: Counties: Counties: CYF TAY Adults Older Adults (N=54) (N=59) (N=59) (N=54) Service Strategy N % N % N % N % Specific Positions 51 94.4% 57 96.6% 56 94.9% 51 94.4% Mentors/Peer Adjustment Coaches 36 66.7% 41 69.5% 38 64.4% 39 72.2% Job Coaches 9 16.7% 21 35.6% 25 42.4% 18 33.3% Educational Coaches/Tutors 11 20.4% 21 35.6% 22 37.3% 18 33.3% Case Managers 7 13.0% 13 22.0% 14 27.3% 13 24.1% Parent Educators 21 38.9% 25 42.4% 19 32.2% 15 27.8% Peer Educators 29 53.7% 42 71.2% 47 79.7% 47 87.0% Advocates 24 44.4% 32 54.2% 36 61.0% 28 51.9% TOTAL 51 94.4% 57 96.6% 56 94.9% 51 94.4% The inclusion of consumers/family members on staff was documented for nearly all counties - 94.4 to 96.6 percent of the counties. Strategies where Peers are part of the Team According to Solomon (2004), peer support can be defined as ‘‘social emotional support, frequently coupled with instrumental support, that is mutually offered or provided by persons having a mental health condition to others 74 sharing a similar mental health condition to bring about a desired social or personal change’’ (p. 699). Peers often provide services such as outreach and engagement programs, run social and recreational activities; provide child care support, housing support and transportation; provide support with instrumental needs such as housekeeping, grocery shopping and other general needs. Peers also offer peer-run self-help classes, a warm-line and drop-in centers, where clients can go and receive support for specific needs. The number of counties using specific strategies when employing peers/parent advocates is summarized by age group across the counties/municipalities in Table III.7. 74 As seen in Schutt, R. K., & Rogers, E. (2009). Empowerment and peer support: structure and process of self-help in a consumer-run center for individuals with mental illness. Journal Of Community Psychology, 37(6), 697-710. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 30 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table III.7 Number and Percent of Counties Reporting Planned Implementation of Full Service Partnership Basic Services – Peer Support – Strategies where Peers are part of Team Counties: Counties: Counties: Counties: CYF TAY Adults Older Adults (N=54) (N=59) (N=59) (N=54) Service Strategy N % N % N % N % Strategies Involving Peers on Team 50 92.6% 54 91.5% 55 93.2% 50 92.6% Drop-In Centers/Club House 16 29.6% 26 44.1% 27 45.8% 24 44.4% Warm Line 12 22.2% 13 22.0% 15 25.4% 13 24.1% Outreach and Engagement 30 55.6% 36 61.0% 38 64.4% 36 66.7% Social Recreation 22 40.7% 36 61.0% 34 57.6% 29 53.7% Child Care Support 3 6.0% 5 8.5% 3 5.1% 1 1.9% Transportation 16 29.6% 22 37.3% 22 37.3% 22 40.7% Housing Support 10 18.5% 19 32.2% 21 35.6% 18 33.3% Classes (e.g., self-help) 14 25.9% 22 37.3% 25 42.4% 19 32.2% Instrumental Support (e.g., housekeeping) 3 6.0% 5 8.5% 7 11.9% 10 18.5% Grounds-keeping/Facility Maintenance 0 0.0% 1 1.7% 1 1.7% 1 1.9% In-Home Support 3 6.0% 4 6.8% 5 8.5% 8 13.6% Respite Care 2 3.7% 3 5.1% 2 3.4% 2 3.7% Crisis Intervention 7 13.0% 10 17.0% 10 17.0% 11 20.4% Rehabilitation 0 0.0% 6 10.2% 10 17.0% 6 11.1% Violence/Trauma Recovery 1 1.9% 1 1.7% 2 3.4% 2 3.7% TOTAL 50 92.6% 54 91.5% 55 93.2% 50 92.6% Nearly all counties gave examples of the specific strategies peers/parent advocates engaged in as FSP team members. Peers Augmenting the Overall Capacity of the Staff Team In a comprehensive review of self-help and consumer-operated programs to date, Campbell (2005) examined several studies of self-help programs for mental health clients which, taken together, suggest that self-help and peer support programs can promote empowerment and recovery increase social support, functioning, and activities (p. 699). 75 Participants learned from others how to meet the needs of people in situations similar to theirs and then taught others how to meet their own needs in the same ways. Through this process of learning and sharing, Center participants developed a sense of their own capacities and strengthened their bonds with others 76 (p. 706). Peers augment the program by running support groups an various topics, fill ethnic disparities, share their personal stories and teach socialization and communication skills. Furthermore, peers are aware of community services and collaborate with other agencies in order to provide the best and most appropriate services to their peers. 75 As seen in Schutt, R. K., & Rogers, E. (2009). Empowerment and peer support: structure and process of self-help in a consumer-run center for individuals with mental illness. Journal of Community Psychology, 37(6), 697-710. 76 Ibid. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 31 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets The number of counties citing specific ways in which peers/parent advocates augment the overall capacity of the team is summarized by age group across the counties/municipalities in Table III.8. Table III.8 Number and Percent of Counties Reporting Implementation of Full Service Partnership Services – Peer Support – Peers Augmenting the Overall Capacity of the Staff Team Counties: Counties: Counties: Counties: CYF TAY Adults Older Adults (N=54) (N=59) (N=59) (N=54) Service Strategy N % N % N % N % Peers Augmenting Overall Capacity 48 88.9% 58 98.3% 57 96.6% 53 98.1% Support Groups 32 59.3% 45 76.3% 47 79.7% 44 81.2% Cultural Competence 30 55.6% 40 67.8% 40 67.8% 36 66.7% LGBTQ 6 10.2% 11 18.6% 9 15.3% 8 13.6% Clinical & Family/Peer Support 28 51.9% 36 61.0% 38 64.4% 33 61.1% Consumer Experience 4 7.4% 9 15.3% 9 15.3% 7 13.0% Collaboration with Other Agencies/Community 21 38.9% 31 52.5% 38 64.4% 37 68.5% Recruitment and Hiring 20 37.0% 28 47.5% 30 50.9% 26 48.1% Socialization Skills 7 13.0% 11 18.6% 10 17.0% 11 20.4% Communication Skills 2 3.7% 3 5.1% 3 5.1% 3 5.6% TOTAL 48 88.9% 58 98.3% 57 96.6% 53 98.1% Up to 98.3 percent of counties (all serve adults) noted ways in which clients and family members were planned to augment the team, but not all cited specific roles or current employment of peers/parent advocates (see Tables III.6 and III.7). 8. Housing Housing, for the purpose of this study, is defined as: 77 1) Project-Based Housing Program, per California Code of Regulation (Barclays Official), Title 9. Rehabilitative and Developmental Services, Division 1. Department of Mental Health, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3630.05 Project-Based Housing Program. Per Subsection (a): 77 Housing, for the purpose of this study, is defined as: 1) Project-Based Housing Program, per California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3630.05. Project-Based Housing Program. Per Subsection (a): The County may use General System Development funds for costs associated with Project-Based Housing… 2) Mental Health Services Act Housing Program Service Category, per California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.225. Mental Health Services Act Housing Program Service Category. “Mental Health Services Act Housing Program Service Category” means the service category of the Community Services and Supports component of the Three-Year Program and Expenditure Plans under which Mental Health Services Act funds, administered through the California Housing Finance Agency, are used to acquire, rehabilitate, or construct permanent supportive housing for clients with serious mental illness and provide operating subsidies. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 32 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets The County may use General System Development funds for costs associated with Project-Based Housing… Mental Health Services Act Housing Program Service Category, per California Code of Regulation (Barclays Official), Title 9. Rehabilitative and Developmental Services, Division 1. Department of Mental Health, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.225 Mental Health Services Act Housing Program Service Category. “Mental Health Services Act Housing Program Service Category” means the service category of the Community Services and Supports component of the Three-Year Program and Expenditure Plans under which Mental Health Services Act funds, administered through the California Housing Finance Agency, are used to acquire, rehabilitate, or construct permanent supportive housing for clients with serious mental illness and provide operating subsidies. Findings: Housing The number of counties citing specific housing efforts in their plans/updates is summarized by age group across the counties/municipalities in Table III.9. Table III.9 Number and Percent of Counties Reporting Implementation of Full Service Partnership Services – Housing Counties: Counties: Counties: Counties: CYF TAY Adults Older Adults (N=54) (N=59) (N=59) (N=54) Service Strategy N % N % N % N % Housing 37 68.5% 55 93.2% 56 94.9% 43 79.6% 9. FSP Team Composition Guidance for FSP team structure comes from the federal Substance Abuse and Mental Health Services Administration. Recommendations related to the number of psychiatrists, nurse practitioners, and social workers are provided. In addition, collaboration through a team approach is the recommended standard of care. 78 Number of Psychiatrist/Nurse Practitioner Staff Guidelines provided by the Substance Abuse and Mental Health Services Administration (SAMHSA) suggest that one full-time psychiatrist be on staff for every 100 clients. In addition to serving as the program’s medical director, SAMHSA advises that the psychiatrist be fully integrated into the service team (rather than functioning solely to prescribe medication, as was the case historically). The other crucial team member is the nurse practitioner – two 79 full-time staff members are recommended for every 100 clients. 78 Substance Abuse and Mental Health Services Administration. (2008). Assertive Community Treatment: Building Your Program. DHHS Pub. No. SMA-08-4344, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. When applying criteria to counties/municipalities with proposed caseloads fewer than 100, the ratio was applied fractionally. 79 Ibid. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 33 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Number of Social Worker Staff SAMHSA guidelines suggest that a social worker on staff meet at least once a week with each client on his/her caseload. 80 Team Approach 81 The SAMHSA stricture to function as a team, rather than in independent silos fits nicely with the MHSA requirement for seamless, integrated services. 82 Findings: Composition of MHSA Team The number of counties citing specific best practices related to the FSP team is summarized by age group across the counties/municipalities in Table III.10. Table III.10 Number and Percent of Counties Reporting Implementation of Full Service Partnership Services – Composition of FSP Team Counties: Counties: Counties: Counties: CYF TAY Adults Older Adults (N=54) (N=59) (N=59) (N=54) Service Strategy N % N % N % N % MH Staff 33 61.1% 42 77.8% 44 74.6% 43 79.6% Number of Psychiatrist/Nurse Practitioner Staff 25 46.3% 28 47.5% 31 52.5% 33 61.1% Number of Social Worker Staff 22 40.7% 25 42.4% 26 44.1% 23 42.6% Team Approach 24 44.4% 33 55.9% 32 54.2% 31 57.4% TOTAL 33 61.1% 42 77.8% 44 74.6% 43 79.6% Specific best practices with regard to team composition were cited by 61.1 to 79.6 percent of counties, depending upon the age group served by the FSP team. 10. Co-Occurring Disorders The California Code of Regulations includes “cost of treatment of co-occurring conditions, such as substance abuse” in the list of allowable non-mental health services under the Full Service Partnership Service Category. 83 80 Substance Abuse and Mental Health Services Administration. (2008). Assertive Community Treatment: Building Your Program. DHHS Pub. No. SMA-08-4344, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. 81 Ibid. 82 California Department of Mental Health. (2005, August). Mental Health Services Act Community Services and Supports Three-Year Program Expenditure Plan Requirements. http://www.dmh.ca.gov/dmhdocs/docs/letters05/05-05CSS.pdf 83 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620. Full Service Partnership Service Category. Scroll down to (a) (1) (B) for examples of non-mental health services and supports allowable under the Full Service Partnership Service Category. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 34 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Substance Abuse Treatment Services Additional recommendations include provision of service through an integrated team and in a parallel time frame, as compared with the “services as usual” model where mental health services and substance abuse treatment services are completely separate, and provided sequentially. 84 Table III.11 Number and Percent of Counties Reporting Implementation of Full Service Partnership Services – Co-Occurring Disorders Services Counties: Counties: Counties: Counties: CYF TAY Adults Older Adults (N=54) (N=59) (N=59) (N=54) Service Strategy N % N % N % N % Substance Abuse Treatment 28 51.9% 49 83.1% 49 83.1% 38 70.4% Linkage to substance abuse treatment for FSPs with co-occurring disorders was documented by 51.9 to 83.1 percent of counties, depending upon the age group. 11. Evidence-Based Practices Only one evidence-based model was mandated (Wraparound for Children). 85 Use of additional evidence-based models was left to the discretion of counties/municipalities. Evidence Based Practices (EBP) are becoming more and more essential in today’s psychological environment. According to Drake et al (2001), EBPs are “interventions for which there is consistent scientific evidence showing that they improve client outcomes’’ and is equivalent to terms more commonly used in broader mental health settings and psychology, ‘‘empirically supported interventions’’ and ‘‘empirically supported treatments’’ (p. 370). 86 Wellness Recovery Action Plan The Wellness Recovery Action Plan (WRAP) was developed in the true spirit of empowering individuals with mental 87 illness, in that it requires active input from the individual. It can be completed alone or with assistance. The key is that the process is directed by the individual. Key elements of WRAP include: Daily Maintenance Plan Identifying Triggers and an Action Plan Identifying Early Warning Signs and an Action Plan Identifying When Things Are Breaking Down and an Action Plan Crisis Planning 84 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620. Full Service Partnership Service Category. Scroll down to (a) (1) (B) for examples of non-mental health services and supports allowable under the Full Service Partnership Service Category. 85 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620. Full Service Partnership Service Category. Scroll down to (a) (1) (C) for specific language requiring wraparound services for children under the Full Service Partnership Service Category. 86 Stanhope, V., Tuchman, E., & Sinclair, W. (2011). The Implementation of Mental Health Evidence Based Practices from the Educator, Clinician and Researcher Perspective. Clinical Social Work Journal, 39(4), 369-378. 87 Copeland, M.E. Wellness Recovery Action Plan. Downloaded on 12/1/11. http://www.mentalhealthrecovery.com/wrap Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 35 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Post Crisis Planning The Wellness Recovery Action Plan (WRAP) is an intervention geared towards Adults (26-55 years of age) with a 88 mental illness and is typically implemented in a group setting. According to Copeland et al., (2004), WRAP “is a self-management system designed by consumers, assisting people to identify the factors that contribute to or 89 prolong unwellness.” (p. 450). The Plan aims to create an action plan to manage these factors and plan for what 90 will happen to them if the clients are no longer able to make a decision (p. 450). WRAP is designed to help individuals rebuild their “pathway to recovery” using two important parts: 1. five key concepts of mental health recovery (hope, personal responsibility, education, self-advocacy and support) and, 2. six self-management systems (wellness tool box, daily maintenance plan, triggers and plan, early warning signs and plan, when things have broken down and plan, and a crisis 91 plan). (p. 94) Cognitive Behavioral Therapy Cognitive Behavioral Therapy (CBT) is an educational model that has been widely used to treat anxiety, mood, and 92 psychotic disorders (Caroff & Beck, 2005) within the general population (p. 264). According to Velting, Setzer, and Albano (2004), there are six main components to CBT: 1. psychoeducation, 2. somatic management, 3. cognitive restructuring, 4. problem-solving, 5. exposure, and 93 6. relapse prevention (p. 264). According to Beck (1995), techniques typically used with CBT include “teaching individuals to monitor affect, 94 physical arousal, and cognition to gain greater self-awareness and identify targets for change.” (p. 134). CBT can be used with a variety of ages. According to SAMHSA’s National Registry of Evidence-based Programs and Practices, this model can be used with youth (13-17 years of age) and young adults (18-25 years of age) who are suffering from anxiety and/or depression. 95 When treating adolescents, the following is emphasized: 88 SAMHSA’s National Registry of Evidence-based Programs and Practices. Wellness Recovery Action Plan (WRAP). http://www.nrepp.samhsa.gov/ 89 As seen in, Doughty, C. (2008). The Wellness Recovery Action Plan (WRAP): workshop evaluation. Australasian Psychiatry, 16, 450-456. 90 Ibid. 91 As seen in Wenli, Z., Suet Yi, W., Yanbing, L., Hong-Shiow, Y., & Yue, Z. (2009). The Wellness Recovery Action Plan (WRAP): Effectiveness with Chinese consumers. Aotearoa New Zealand Social Work Review, 21/22(4/1), 94-102. 92 Rotheram-Fuller, E. (2011). Cognitive-behavioral therapy for children with autism spectrum disorders. Psychology in the Schools, 48, 263-271. 93 Ibid. 94 Macrodimitris, S. J. (2010). CBT basics: A group approach to teaching fundamental cognitive-behavioral skills. Journal of Cognitive Psychotherapy, 24, 132-146. 95 SAMHSA’s National Registry of Evidence-based Programs and Practices: Cognitive Behavioral Therapy. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 36 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 1. the use of concrete examples to illustrate points, 2. education about the nature of psychotherapy and socialization to the treatment model, 3. active exploration autonomy and trust issues, 4. focus on cognitive distortions and affective shifts that occur during sessions, and 5. acquisition of problem-solving, affect-regulation, and social skills. 96 The model has also been successful with “rural older adults, evidencing lower literacy and diminishment of cognitive resources.” (p. 510). 97 According to a study conducted by Crowther (2010), “older adults are well-suited to cognitive and behavioral therapies utilizing a collaborative, explicit goal setting, and acknowledgment of their strengths.” (p. 502). 98 Since psychoeducation is a major component in this model, individuals are often considering the process as a “learning experience” rather than a “psychological treatment” (p. 504). 99 This can be advantageous to older adults who were not raised to utilize psychological principles. Dialectical Behavior Therapy Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment approach with two key characteristics: a behavioral, problem-solving focus blended with acceptance-based strategies, and an emphasis on dialectical processes. 100 DBT consists of five key components: 1. capability enhancement (skills training); 2. motivational enhancement (individual behavioral treatment plans); 3. generalization (access to therapist outside clinical setting, homework, and inclusion of family in treatment); 4. structuring of the environment (programmatic emphasis on reinforcement of adaptive behaviors); and 5. capability and motivational enhancement of therapists (therapist team consultation 101 group). DBT emphasizes balancing behavioral change, problem-solving, and emotional regulation with validation, mindfulness, and acceptance of patients. 102 DBT has been found to be a useful evidence based practice with individuals 18 years of age and older and has been found to be useful in treating a variety of disorders. For example, according to Harned, Jackson, Comtois and Linehan’s (2010) findings, DBT significantly decreases exclusionary behaviors for PTSD treatment among suicidal 103 and/or self-injuring clients with Borderline Personality Disorder and Posttraumatic Stress Disorder (p. 424). DBT for post-traumatic stress disorder aims to help patients “(a) reduce their fear of trauma-associated primary http://www.nrepp.samhsa.gov/ 96 Ibid. 97 Crowther, M. (2010). Treating the aged in rural communities: the application of cognitive-behavioral therapy for depression. Journal of Clinical Psychology, 66, 502-512. 98 Ibid. 99 Ibid. 100 SAMHSA’s National Registry of Evidence-based Programs and Practices. Dialectical Behavior Therapy. http://www.nrepp.samhsa.gov/ 101 Ibid. 102 Ibid. 103 Harned, M. S., Jackson, S. C., Comtois, K. A., & Linehan, M. M. (2010). Dialectical behavior therapy as a precursor to PTSD treatment for suicidal and/or self-injuring women with borderline personality disorder. Journal of Traumatic Stress, 23, 421-429. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 37 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets emotions, (b) question secondary emotions like guilt and shame, and (c) radically accept trauma facts” (p. 102). 104 DBT views disordered eating and purging as maladaptive methods used to manage, control or change adverse emotional states.” (p. 77). 105 Social Skills Training Social Skills training is a directive, goal-orient process which can be used when working with Children, Transition- Aged youth, Adults and Older Adults. This approach assumes that clients have patterns of relating with others that can be changed for the better (p. 152). 106 According to SAMHSA’s National Registry of Evidence-based Programs and Practices “the social skills training component is based on modules for symptom management, communication 107 role-play, and problem-solving social skills.” Social Skills Training can be used on a variety of ages. One study conducted by Williams (2011), found Social Skills Training has been viewed as quite effective, especially in dealing with youth who report high levels of antisocial or 108 aggressive behaviors. Castorina’s (2011) study supported the contention that “boys with Asperger syndrome can be taught to attend to non-verbal social cues to infer emotions, and that elements of social and emotion perception can be improved though social skills training” (p. 80). 109 Social Skills Training provides individuals the skills needed to interact and understand other individuals in their social surroundings. Behavioral Therapy Behavioral Therapy can be used on individuals as young as children. According to Romero, Donohue and Allen (2010), behavioral interventions “may be effective in treating co-morbid child neglect and substance abuse” (p. 288). 110 Family Behavioral Therapy uses interventions “aimed at teaching substance abusers to avoid or manage stimuli that often precede substance use, such as arguments, anger, places where drugs are present, depression, 111 and anxiety.” (p. 287) Behavioral Couples Therapy can be used to treat adults with substance abuse issues. BCT is a substance abuse treatment approach “based on the assumptions that (1) intimate partners can reward abstinence and (2) reducing relationship distress lessens risk for relapse.” 112 The primary relational goals of BCT are to improve 104 Steil, R., Dyer, A., Priebe, K., Kleindienst, N., & Bohus, M. (2011). Dialectical behavior therapy for posttraumatic stress disorder related to childhood sexual abuse: A pilot study of an intensive residential treatment program. Journal of Traumatic Stress, 24, 102-106. 105 Dennis, A. (2010). Dialectical behavior therapy for binge eating and bulimia. Eating Disorders, 18, 76-78. 106 Lenz, A., Holman, R. L., & Dominguez, D. L. (2010). Encouraging connections: Integrating expressive art and drama Into Therapeutic Social Skills Training with adolescents. Journal of Creativity in Mental Health, 5, 142-157. 107 SAMHSA’s National Registry of Evidence-based Programs and Practices. Social Skills Group Intervention. http://www.nrepp.samhsa.gov/ 108 Williams, C. A. (2011). Mentoring and social skills training: Ensuring better outcomes for youth in foster care. Child Welfare, 90, 59-74. 109 Castorina, L. M. (2011). The inclusion of siblings in social skills training groups for boys with Asperger Syndrome. Journal of Autism & Developmental Disorders, 41, 73-81. 110 Romero, V., Donohue, B., & Allen, D. (2010). Treatment of concurrent substance dependence, child neglect and domestic violence: A single case examination involving Family Behavior Therapy. Journal of Family Violence, 25, 287-295. 111 Ibid. 112 SAMHSA’s National Registry of Evidence-based Programs and Practices. Behavioral couples therapy for alcoholism and drug abuse. http://www.nrepp.samhsa.gov/ Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 38 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets communication and increase positivity and commitment. To achieve these goals, the therapist teaches effective 113 listening, conflict resolution, and problem-solving skills (p. 441). Modeling Modeling is a method used in specific techniques of psychotherapy. When using this technique, the client learns by 114 imitation alone, without any specific verbal direction by the therapist. This technique is often used with Children and Youth, but can also be used with Adults and Older Adults. Family Psychoeducation Family Psychoeducation is an approach often used when working with an individual’s disorder and need to include the family. “Psychoeducational approaches offer specific educational content regarding the phenomenology, etiology, course, and treatment of specific disorders.” (p. 375). 115 Such programs are offered in an individual family format or in a multi-family workshop format, in order for them to learn about the disorder, its course, 116 prognosis, medications, and management (p. 373). “Psychoeducational approach presents psychiatric disorders as illnesses over which the impaired individual has little or no control. First and foremost, this approach is taken to prevent family members from blaming and criticizing the patient.” (p. 373) 117 At the same time, “the family also is offered support, validation, and recognition for their own difficult experiences in living with a mentally ill family 118 member.” (p. 374) Working with the families is important when working with children or adolescents. Brent, Poling, McKain, and Baugher (1993), found that after a two-hour presentation about depression, parents significantly increased their knowledge about depression and modified some dysfunctional beliefs about depression (e.g., that depressive symptoms are manipulative and that the adolescents should be able to "pull themselves out of it." p. 376) 119 Such shifts in thought may influence how the family views the patient which may in return impact his or her progress. When working with adults and their families, psychoeducation is tailored to certain “aspects of a diagnosis, sociocultural group, or setting is important for effectiveness, it is clear that the usefulness of information, skill building, problem-solving, social support, and reducing social isolation are common across these variations.” (p. 120 108) Multisystemic Therapy Multisystemic Therapy (MST) “stands out as a culturally competent home-based service with strong empirical evidence for treating certain populations in the juvenile justice system (Burns et al., 1999), emerging evidence of effectiveness in the child welfare system, and may have promise for treating youth with a serious emotional 113 Ruff, S., McComb, J. L., Coker, C. J., & Spenkle, D. H. (2010). Behavioral couples therapy for the treatment of substance abuse: A substantive and methodological review of O'Farrell, Fals-Stewart, and colleagues' program of research. Family Process, 49, 439-456. 114 VandenBoss, Gary (2006). APA dictionary of psychology. Washington, DC: American Psychological Association. 115 Fristad, M. A., Gavazzi, S. M., Centolella, D. M., & Soldano, K. W. (1996). Psychoeducation: A promising intervention strategy for families of children and adolescents with mood disorders. Contemporary Family Therapy: An International Journal, 18(3), 371-383. 116 Ibid. 117 Ibid. 118 Ibid. 119 Ibid. 120 Lucksted, A., McFarlane, W., Downing, D., & Dixon, L. (2012). Recent developments in family psychoeducation as an evidence-based practice. Journal of Marital & Family Therapy, 38(1), 101-121. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 39 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 121 disturbance in the community mental health system.” (p. 191) MST encourages therapists to strive to create strong collaborative relationships with their clients. MST therapists strive to highlight youth and family strengths 122 throughout treatment (p. 169). “This strength based approach sets a positive tone for sessions and ultimately motivates clients to address their most difficult problems.” Therapists look for potential strengths within multiple contexts, including the individual child (e.g., intelligence, hobbies and interests, social and academic skills), family (e.g., problem-solving ability, affective bonds, financial resources, extended family), peers (e.g., prosocial activities, achievement orientation), school (e.g., management practices, prosocial after-school activities, concerned school personnel), and the neighborhood/community (e.g., concerned and involved neighbors, voluntary associations such as Boys and Girls clubs, recreational opportunities). (p. 123 169) MST has been known to be used for youth (6-17 years of age) and, according to Henggeler et al., (1998), was conceived to treat juvenile offenders, yet it has “much in common with the system of care movement for the treatment of youth with severe emotional impairment within the communities in which they live.” (p. 192). 124 The ultimate goal of MST is to empower families to build a healthier environment through the mobilization of existing 125 child, family, and community resources. Therapeutic Foster Care Therapeutic Foster Care (TFC) “has become a preferred out-of-home placement for youth with severe emotional and behavioral disorders.” (p. 168). 126 Such interventions are geared toward children and youth to help the client set clear and attainable goals (p. 81). 127 According to Southerland et al. (2009), “evidence from randomized trials has shown that TFC reduces problematic behavior, increases pro-social behavior, and leads to better outcomes post-discharge. ” (p. 50) 128 One of the key areas of effective treatment is quality foster parenting training. Children and adolescents in TFC display a wide range of symptoms, and foster parents must be ready to address any or all of them (p. 82). 129 A key feature of a TFC intervention is the treatment parents, who provide care and treatment for troubled youth in their home on a 24/7 basis (p. 50). 130 One of the main requirements of TFC is training parents. The treatment parent in 121 Painter, K. (2010). Multisystemic therapy as an alternative community-based treatment for youth with severe emotional disturbance: Empirical literature review. Social Work in Mental Health, 8, 190-208. 122 Tuerk, E. W. (2012). Collaboration in family therapy. Journal of Clinical Psychology, 68, 168-178. 123 Ibid. 124 Painter, K. (2010). Multisystemic therapy as an alternative community-based treatment for youth with severe emotional disturbance: Empirical literature review. Social Work in Mental Health, 8, 190-208. 125 SAMHSA’s National Registry of Evidence-based Programs and Practices. Multisystemic Therapy (MST) for juvenile offenders. http://www.nrepp.samhsa.gov/ 126 Breland-Noble, A. M., Farmer, E. Z., Dubs, M. S., Potter, E., & Burns, B. J. (2005). Mental health and other service use by youth in therapeutic foster care and group homes. Journal of Child & Family Studies, 14, 167-180. 127 Sheperis, C. (2003). In-home treatment of Reactive Attachment Disorder in a therapeutic foster care system: A case example. Journal of Mental Health Counseling, 25, 76. 128 Southerland, D., Mustillo, S., Farmer, E., Stambaugh, L., & Murray, M. (2009). What’s the relationship got to do with it? Understanding the therapeutic relationship in therapeutic foster care. Child & Adolescent Social Work Journal, 26, 49-63. 129 Sheperis, C. (2003). In-home treatment of Reactive Attachment Disorder in a therapeutic foster care system: A case example. Journal of Mental Health Counseling, 25, 76. 130 Southerland, D., Mustillo, S., Farmer, E., Stambaugh, L., & Murray, M. (2009). What’s the relationship got to do with it? Understanding the therapeutic relationship in therapeutic foster care. Child & Adolescent Social Work Journal, 26, 49-63. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 40 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets TFC fulfills dual roles: (1) the parent role of nurturing and taking care of the child’s basic needs; and (2) the treatment role, directly implementing treatment interventions with the youth (p. 50). 131 Clear development of a treatment plan with measurable goals and outcomes, continued training of foster parents, utilization of a multidisciplinary treatment team approach, and a consistent therapeutic relationship are essential elements in 132 reducing the disruptive behavior and stabilizing disrupted attachment patterns (p. 87). Parent-Child Interaction Therapy Parent-Child Interaction Therapy (PCIT) is a treatment program for young children with conduct disorders that places emphasis on improving the quality of the parent-child relationship and changing parent-child interaction 133 patterns. PCIT was developed for children ages 2-7 years. In PCIT, parents are taught specific skills to establish or strengthen a nurturing and secure relationship with their child while encouraging prosocial behavior and 134 discouraging negative behavior. PCIT incorporates parent and child in the treatment sessions and uses live, individualized therapist coaching for an idiographic approach to changing the dysfunctional parent-child relationship (p. 488). 135 This treatment has two phases, each focusing on a different parent-child interaction: 136 child-directed interaction and parent-directed interaction. Wraparound Only one evidence-based model was mandated (Wraparound for Children). 137 Per Welfare and Institutions Code 138 18250 - 18258: 139 CHAPTER 4. County Wraparound Services Program [18250. - 18258.] 140 18250: (a) It is the intent of the Legislature that all counties be authorized to provide children with service alternatives to group home care through the development of expanded family based services programs. These programs shall include individualized or “wraparound” services, where services are wrapped around a child living with his or her birth parent, relative, 131 Southerland, D., Mustillo, S., Farmer, E., Stambaugh, L., & Murray, M. (2009). What’s the relationship got to do with it? Understanding the therapeutic relationship in therapeutic foster care. Child & Adolescent Social Work Journal, 26, 49-63. 132 Sheperis, C. (2003). In-home treatment of Reactive Attachment Disorder in a therapeutic foster care system: A case example. Journal of Mental Health Counseling, 25, 76. 133 SAMHSA’s National Registry of Evidence-based Programs and practices. Parent-Child Interaction Therapy. http://www.nrepp.samhsa.gov/ 134 Ibid. 135 Timmer, S. G., Ware, L. M., Urquiza, A. J., & Zebell, N. M. (2010). The effectiveness of Parent-Child Interaction Therapy for victims of interparental violence. Violence & Victims, 25, 486-503. 136 SAMHSA’s National Registry of Evidence-based Programs and practices. Parent-Child Interaction Therapy. http://www.nrepp.samhsa.gov/ 137 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620. Full Service Partnership Service Category. Scroll down to (a) (1) (C) for specific language requiring wraparound services for children under the Full Service Partnership Service Category. 138 Welfare and Institutions Code (WIC), Division 9. Public Social Services, Part 6. Miscellaneous Provisions, Chapter 4. County Wraparound Services Program, 18250 - 18250. Wraparound requirements per WIC are repeated verbatim – therefore, spelling and grammatical errors have not been corrected from the original text. 139 (Heading of Chapter 4 amended by Stats. 2010, Ch. 561, Sec. 1.) 140 (Amended by Stats. 2012, Ch. 35, Sec. 144. Effective June 27, 2012.) Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 41 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets nonrelative extended family member, 141 adoptive parent, licensed or certified foster parent, or guardian. The wraparound services developed under this section shall build on the strengths of each eligible child and family and be tailored to address their unique and changing needs. (b) It is further the intent of the Legislature that the county wraparound services program include the following elements: (1) Enabling the county to access all possible sources of federal funds for the purpose of developing family based service alternatives. (2) Encouraging collaboration among persons and entities including, but not limited to, parents, county welfare departments, county mental health departments, county probation departments, county health departments, special education local planning agencies, school districts, and private service providers for the purpose of planning and providing individualized services for children and their birth or substitute families. (3) Ensuring local community participation in the development and implementation of wraparound services by county placing agencies and service providers. (4) Preserving and using the service resources and expertise of nonprofit providers to develop family based and community-based service alternatives. (c) Beginning in the 2011–12 fiscal year, and for each fiscal year thereafter, funding and expenditures for programs and activities under this section shall be in accordance with the requirements provided in Sections 30025 and 30026.5 of the Government Code. 18251: 142 As used in this chapter: (a) “County” means each county participating in an individualized or wraparound services program. (b) “County placing agency” means a county welfare or probation department, or a county mental health department. (c) “Eligible child” means a child or nonminor dependent, 143 who is any of the following: (1) A child or nonminor dependent who has been adjudicated as either a dependent, 144 transition dependent, or ward of the juvenile court and who would be placed in a group home licensed by the department at a rate classification level of 10 or higher. 141 As defined in Section 362.7. 142 (Amended by Stats. 2012, Ch. 846, Sec. 62. Effective January 1, 2013.) 143 As described in subdivision (v) of Section 11400. 144 Pursuant to Section 300, 450, 601, or 602. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 42 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets (2) A child or nonminor dependent who is currently, or who would be, placed in a group home licensed by the department at a rate classification level of 10 or higher. (3) A child who is eligible for adoption assistance program benefits when the responsible public agency has approved the provision of wraparound services in lieu of out-of-home placement care at a rate classification level of 10 or higher. (d) “Wraparound services” means community-based intervention services that emphasize the strengths of the child and family and includes the delivery of coordinated, highly individualized unconditional services to address needs and achieve positive outcomes in their lives. (e) “Service allocation slot” means a specified amount of funds available to the county to pay for an individualized intensive wraparound services package for an eligible child. A service allocation slot may be used for more than one child on a successive basis. 145 18252: Each county shall, at the county’s option, develop a county plan for intensive wrap-around services and monitor the provision of those services in accordance with the plan. This plan shall be submitted to the department for informational purposes. Where a county operates both systems of care under the Children’s Mental Health Services Act, Part 4 (commencing with Section 5850) of Division 5, and wrap-around services, these plans shall be coordinated. Each county’s plan shall include all the following elements: (a) A process and protocol for reviewing the eligibility of children and families for service and for monitoring accessibility and availability of service to the targeted population. Children shall 146 be determined as eligible for wrap-around services, except that: (1) Once a child is determined to be eligible for wrap-around services under this chapter, he or she shall remain eligible for the time period specified in his or her individualized services plan. (2) A child and family participating in a family maintenance services program 147 and the wrap-around services program, shall not be subject to the time limitations specified in Section 16506. (b) A process to accept, modify, or deny proposed individualized service plans for eligible children and families. (c) A process for parent support, mentoring, and advocacy that ensures parent understanding of, and participation in, wrap-around services programs. 145 (Amended by Stats. 1997, Ch. 795, Sec. 3. Effective January 1, 1998.) 146 Pursuant to subdivision (c) of Section 18251. 147 As described in Section 16506. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 43 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets (d) A planning and review process to support and facilitate the following principles in delivering intensive wrap-around services to eligible children and families: (1) Focusing on an individual child and family through the creation of service plans designed specifically to address the unique needs and strengths of each child and his or her family. (2) Providing services geared toward enabling children to remain in the least restrictive, most family-like setting possible. (3) Developing a close collaborative relationship with each child’s family in the planning and provision of wrap-around services. (4) Conducting a thorough, strengths-based assessment of each child and family that will form the basis for the development of the individualized intervention plan. (5) Designing and delivering services that incorporate the religious customs, and regional, racial, and ethnic values and beliefs of the children and families served. (6) Measuring consumer satisfaction to assess outcomes. (e) Written interagency agreements or memorandums of understanding between the county departments of mental health, social services, and probation that specify jointly provided or integrated services, staff tasks and responsibilities, facility and supply commitments, budget considerations, and linkage and referral services. 148 18253: Each county shall ensure that an evaluation of the wraparound services program is conducted to determine the cost and treatment effectiveness of outcomes such as family functioning and social performance, preventing placement in more restrictive environments, improving emotional and behavioral adjustments, school attendance, and stability in the least restrictive school placement for eligible children. Systems of care outcomes shall be included to the extent they are applicable to the target population. 149 18253.5: Each county shall ensure that staff participating in the wraparound services program have completed training provided or approved by the department, on providing individualized wraparound services. 148 (Amended by Stats. 2010, Ch. 561, Sec. 4. Effective January 1, 2011.) 149 (Amended by Stats. 2010, Ch. 561, Sec. 5. Effective January 1, 2011.) Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 44 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 18254: 150 (a) Rates for wraparound services, under the wraparound services program, shall be based on the following factors: (1) The average cost of rate classification 10 to 11 in each county, minus the cost of any concurrent out-of-home placement, for children who are or would be placed in a rate level 10 or 11 group home. (2) The average cost of rate classification 12 to 14 in each county, minus the cost of any concurrent out-of-home placement, for children who are or would be placed in a rate level 12 to 14 group home. (b) (1) Prior to the 2011–12 fiscal year, the department shall reimburse each county, for the purpose of providing intensive wraparound services, up to 100 percent of the state share of nonfederal funds, to be matched by each county’s share of cost as established by law, and to the extent permitted by federal law, up to 100 percent of the federal funds allocated for group home placements of eligible children, at the rate authorized pursuant to subdivision (a). (2) Beginning in the 2011–12 fiscal year, and for each fiscal year thereafter, funding and expenditures for programs and activities under this section shall be in accordance with the requirements provided in Sections 30025 and 30026.5 of the Government Code. (c) County, and to the extent permitted by federal law, federal, foster care funds shall remain with the administrative authority of the county, which may enter into an interagency agreement to transfer those funds, and shall be used to provide intensive wraparound services. (d) Costs for the provision of benefits to eligible children, at rates authorized by subdivision (a), through the wraparound services program authorized by this chapter, shall not exceed the costs which would otherwise have been incurred had the eligible children been placed in a group home. 18256: 151 The department shall work with the County Welfare Directors Association of California to identify periodic data elements to be collected in order to track the impact of the counties’ wraparound services programs on applicable California Child and Family Services Review System outcome indicators, such as safety, permanency, and the well-being of the child. 150 (Amended by Stats. 2012, Ch. 35, Sec. 145. Effective June 27, 2012.) 151 (Repealed and added by Stats. 2010, Ch. 561, Sec. 9. Effective January 1, 2011.) Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 45 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 18256.5: 152 In order to prevent disruption to a child participating in a wraparound services program, any county that terminates its wraparound services program shall ensure the participating child’s service needs are met without disruption until his or her case is closed. 153 18257: The State Department of Social Services shall seek applicable federal approval to make the maximum number of children being served through such programs eligible for federal financial participation and amend any applicable state regulations to the extent necessary to eliminate any limitations on the numbers of children who can participate in these programs. 18258: (a) A child who is categorically eligible for Medi-Cal benefits pursuant to Section 1396a(a)(10)(A)(i)(I) of Title 42 of the United States Code shall remain eligible for Medi-Cal benefits so long as foster care maintenance payments under Title IV-E of the federal Social Security Act are made on the child’s behalf. Placement at home without a change in the child’s status as an adjudicated dependent or ward of the juvenile court shall not be cause for a redetermination unless necessary to obtain federal financial participation for Medi-Cal. (b) A child who is eligible for Medi-Cal benefits, but is not described in subdivision (a), shall 154 remain eligible for benefits subject to annual Medi-Cal redetermination. Placement at home without a change in the child’s status as an adjudicated dependent or ward of the juvenile court shall not be cause for a redetermination unless necessary to obtain federal financial participation for Medi-Cal. (c) Medi-Cal eligibility for a child receiving wraparound services pursuant to this chapter shall be determined in accordance with the standards, methodologies, and procedures outlined in Chapter 7 (commencing with Section 14000) of Part 3 of Division 9. (d) This section is declaratory of existing law. Partners in Care Partners in Care (PIC) is an intervention for use in managed primary care settings to improve the treatment of 155 depression. PIC is based on collaborative care models, in which mental health is integrated with primary care. The core elements of PIC include teamwork between specialists and generalists, case management by nurses, and patient education and empowerment. The intervention educates clinicians on the treatment of depression in the primary care setting while also giving them access to psychotherapists who can provide consultation on difficult 152 (Amended by Stats. 2010, Ch. 561, Sec. 10. Effective January 1, 2011.) 153 (Amended by Stats. 2012, Ch. 35, Sec. 147. Effective June 27, 2012. Note: This section was added on Nov. 2, 2004, by initiative Prop. 63. Prop. 63 allows, under conditions in Sec. 18, the Legislature to directly amend its provisions by 2/3 vote.) 154 Pursuant to Section 14012. 155 SAMHSA’s National Registry of Evidence-based Programs and practices. Partners in Care. http://www.nrepp.samhsa.gov/ Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 46 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 156 cases and take referrals when needed. PIC is most often used when treating Adults and Older Adults, but can also be used when treating Transition-Aged Youth. Findings: Evidence-Based Practices Evidence-Based Practices (EBP) are becoming more and more essential in today’s psychological environment. According to Drake et al (2001), EBPs are “interventions for which there is consistent scientific evidence showing that they improve client outcomes’’ and are equivalent to terms more commonly used in broader mental health settings and psychology, ‘‘empirically supported interventions’’ and ‘‘empirically supported treatments’’ (p. 370). 157 Table III.12 Number and Percent of Counties Reporting Planned Implementation of Full Service Partnership Value-Added Services – Evidence-Based Practices Counties: Counties: Counties: Counties: CYF TAY Adults Older Adults (N=54) (N=59) (N=59) (N=54) Service Strategy N % N % N % N % Evidence-Based Practices 41 75.9% 45 76.3% 49 83.1% 32 59.3% Wellness Recovery Action Plan 35 59.3% 40 67.8% 22 40.7% Cognitive Behavior Therapy 14 25.9% 15 25.4% 12 20.3% 7 13.0% Dialectical Behavior Therapy 8 13.6% 6 10.2% 4 7.4% Social Skills Training 13 24.1% 20 33.9% 14 27.3% 10 18.5% Behavior Therapy 12 22.2% 12 20.3% 10 17.0% 9 16.7% Modeling 4 7.4% 6 10.2% 5 8.5% 4 7.4% Family Psychoeducation 14 25.9% 19 32.2% 20 33.9% 19 35.2% Multisystemic Therapy 2 3.7% 3 5.1% Therapeutic Foster Care 6 11.3% Parent-Child Interaction Therapy 12 22.2% Wraparound 38 70.4% Partners In Care 1 1.7% 1 1.9% TOTAL 41 75.9% 45 76.3% 49 83.1% 32 59.3% The number of counties citing specific evidence-based practices provided to FSPs is summarized by age group across the counties/municipalities in Table III.12. The majority of counties cited at least one evidence-based practice provided to each of the age groups served by the FSP (59.3 to 83.1 percent). 156 SAMHSA’s National Registry of Evidence-based Programs and practices. Partners in Care. http://www.nrepp.samhsa.gov/ 157 Stanhope, V., Tuchman, E., & Sinclair, W. (2011). The implementation of mental health evidence based practices from the educator: Clinician and researcher perspective. Clinical Social Work Journal, 39, 369-378. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 47 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 12. Other Practices The California Code of Regulations 158 makes it clear that the use of alternative treatment and culturally specific treatment approaches shall not be prohibited by these regulations. The number of counties reporting alternative and culturally specific treatments is displayed, by age group, in Table III.13. Table III.13 Number and Percent of Counties Reporting Implementation of Full Service Partnership Services – Other Practices Counties: Counties: Counties: Counties: CYF TAY Adults Older Adults (N=54) (N=59) (N=59) (N=54) Service Strategy N % N % N % N % Other Practices 30 50.9% 30 50.9% 33 55.9% 26 66.7% Alternative Treatment 6 10.2% 15 25.4% 12 20.3% 10 18.5% Culturally-Specific Treatment 24 44.4% 26 44.1% 24 40.7% 23 42.6% TOTAL 30 50.9% 30 50.9% 33 55.9% 26 66.7% A little over half of the counties documented other practices for CYF, TAY and Adult FSPs, such as alternative treatments, or culturally-specific treatment. Approximately two-thirds documented other practices in place for Older Adults. 13. Discharge Coordination FSP services are designed to be seamless, and it therefore follows that discharge from a psychiatric facility or long- term care, or from a criminal justice setting, should be coordinated in order to ensure smooth transition back into the community. Table III.14 Number and Percent of Counties Reporting Implementation of Full Service Partnership Services – Discharge Coordination Counties: Counties: Counties: Counties: CYF TAY Adults Older Adults (N=54) (N=59) (N=59) (N=54) Service Strategy N % N % N % N % Discharge Coordination 33 61.7% 40 67.8% 37 62.7% 27 50.0% Hospital Coordination 17 31.5% 20 33.9% 24 40.7% 23 42.6% Criminal Justice Coordination 33 61.1% 40 67.8% 37 62.7% 27 50.0% TOTAL 33 61.7% 40 67.8% 37 62.7% 27 50.0% At least half (50.0 to 67.8 percent of counties, depending upon the age group) document specific practices related to discharge coordination. 158 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620. Full Service Partnership Service Category. Scroll down to (a) (1) (A) (v) for the specific citation. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 48 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 14. FSP Services Summary The overall vision of doing “whatever it takes” to aid individuals with severe mental illness/serious emotional disturbance has given birth to an overall framework under which an organized array of services is provided across the State. UCLA reviewed every county’s Full Service Partnership Plan and Annual Updates in order to generate a county-specific FSP Assessment. 159 The FSP Assessment indicates whether a planned service/activity was present or absent for each age group. The FSP Assessment tool was first developed by an expert consultant, and pilot 160 tested on one county. The tool was then reviewed by the Cost Advisory Group. Revisions were made to the tool based on feedback from the Cost Advisory Group. FSP Assessments were sent back to each county, along with the source location (basis for the present/absent rating). 161 Counties had the opportunity for review/feedback, which included submission of documentary evidence to support FSP activities/practices in place. 162 Based on the FSP Service Summary, the following services are offered across the state to FSPs (summarized in Table III.15). 159 The decision was made to use available data (rather than conduct site visits to each county) in order to avoid burden to the counties, and due to budgetary considerations. 160 Our consultant had worked as a Full Service Partnership Coordinator for a large county. The county reviewed was the county she had worked for, with their permission. Counties were provided the opportunity to provide additional documentary evidence because services may have changed following plan submission, a service may have inadvertently been left out of the plan – in short, the Cost Advisory Group noted that the Plans and Updates were not designed to capture everything offered through the Full Service Partnership, and therefore the opportunity to augment with additional data must be offered to counties. 161 For example, the page number in the original FSP Plan. We provided the source location in order to make it easier for counties to follow the logic for our ratings of whether a given service (e.g., wraparound) was present or absent. 162 One county requested a site visit in order to update their FSP Assessment. The FSP Assessment matrix accompanied the site visitor, and was updated following the visit based on qualitative survey results (interview data with FSP staff). Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 49 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table III.15 Number and Percent of Counties Reporting Implementation of Full Service Partnership Services Counties: Counties: Counties: Counties: CYF TAY Adults Older Adults (N=54) (N=59) (N=59) (N=54) Service Strategy N % N % N % N % Outreach and Engagement* 53 98.1% 59 100% 59 100% 54 100% Personal Services Coordinator/Case Manager* 52 96.3% 58 98.3% 59 100% 52 96.3% General Standards* 54 100% 59 100% 59 100% 54 100% Outpatient Mental Health Services 51 94.4% 58 98.3% 56 94.9% 50 92.6% Other Supports 48 88.9% 57 96.6% 56 94.9% 48 88.9% Specific Positions for Clients/Family Members 51 94.4% 57 96.6% 56 94.9% 51 94.4% Strategies Involving Peers on Team 50 92.6% 54 91.5% 55 93.2% 50 92.6% Peers Augmenting Overall Team Capacity 48 88.9% 58 98.3% 57 96.6% 53 98.1% Housing 40 74.1% 55 93.2% 55 93.2% 43 79.6% Best practices – Team Composition 33 61.1% 42 77.8% 44 74.6% 43 79.6% Substance Abuse Treatment 28 51.9% 49 83.1% 49 83.1% 38 70.4% Evidence-Based Practices 41 75.9% 45 76.3% 49 83.1% 32 59.3% Other Practices 30 50.9% 30 50.9% 33 55.9% 26 66.7% Discharge Coordination 33 61.7% 40 67.8% 37 62.7% 27 50.0% * Services/strategies in Table 1 indicated with an asterisk (*) represent requirements under the Mental Health Services Act. The following conclusions may be drawn regarding services offered to FSPs: At least one of the required strategies is in place for outreach and engagement in all counties serving TAY, Adults and Older Adults, and for 98.1 percent of counties serving CYF. Outpatient mental health services are offered in 92.6 to 98.3 percent of the counties to FSPs, depending upon the age group served. Other support services are offered in 88.9 to 96.6 percent of counties, depending upon the age group served by the FSP. The inclusion of consumers/family members on staff was documented for nearly all counties - 94.4 to 96.6 percent of the counties. Up to 98.3 percent of counties (all serve Adults) noted ways in which clients and family members were planned to augment the team, but not all cited specific roles or current employment of peers/parent advocates. Depending upon the age group served by the FSP, housing is offered 74.1 to 93.2 percent of counties. Specific best practices with regard to team composition were cited by 61.1 to 79.6 percent of counties, depending upon the age group served by the FSP team. Linkage to substance abuse treatment for FSPs with co-occurring disorders was documented by 51.9 to 83.1 percent of counties, depending upon the age group. At least half (50.0 to 67.8 percent of counties, depending upon the age group) document specific practices related to discharge coordination (from hospitals and criminal justice facilities). Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 50 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets IV. Expenditures on Full Service Partnership Programs 163 164 Full Service Partnership expenditures are the focus of this chapter. Translated into plain language – what was expended on Full Service Partnership programs? This deliverable is defined simply as follows: Initial written report that specifies: 1. The statewide and county-specific per-person annual cost average and range for FSP Adults, Older Adults, Children and Transition-Age Youth, and 2. The proportion of revenue by funding source. The chapter opens with a description of our methodology – how we went about calculating the expenditures for Full Service Partnership programs. The chapter closes with statewide Full Service Partnership expenditures by age group. a. Methodology Expenditures on Full Service Partnerships (FSP) were analyzed and reported (through Fiscal Year 08-09) as part of 165 the Phase II Statewide Evaluation of the Mental Health Services Act, Deliverable 1. The primary data source for 166 determining FSP cost was the Revenue and Expenditure Reports. Revenue and Expenditure Reports are completed by each county mental health department, and they document all monies spent and distributed through the Mental Health Services Act. In the process of completing Phase II Deliverable 1, the UCLA Team summarized all public mental health expenditures on Full Service Partnerships documented in the Revenue and Expenditure Reports (RER). Therefore, the RERs were deemed a logical data source to start with. The initial question to be answered, in order for the analysis to proceed, relates directly back to the deliverable language (above): Can FSP service expenditures by age group be calculated using the RERs? Without the ability to determine age-group-specific expenditures, the county-specific and statewide expenditure average and range for FSP Adults, Older Adults, Children and Transition-Age Youth cannot be determined. 163 Although UCLA was tasked with determining costs, we explain in this chapter why the available data sources forced a shift to FSP expenditures when discussing FSP services. Costs are also a focus, but only inasmuch as available public data sources were available, documenting daily consequence cost to county and state systems. 164 Phase III Deliverable 1.A. Initial written report that specifies 1) the statewide and county-specific per-person annual expenditure average and range for FSP Adults, Older Adults, Children and Transition-Age Youth and 2) the proportion of revenue by funding source. 165 http://mhsoac.ca.gov/Announcements/docs/Evaluation_Deliverable1A_Brief2_FSP.pdf California’s Investment in the Public Mental Health System: Proposition 63; Brief 2 of 7: Providing Community Services and Supports through Full Service Partnerships. 166 FY 06-07 was the earliest fiscal year for which Revenue and Expenditure Reports were submitted by counties. No counties submitted Revenue and Expenditure Reports (according to the Department of Mental Health) prior to FY 06-07. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 51 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Therefore, it was imperative for the team to quickly identify a reliable and valid means of determining FSP service 167 expenditures by age group. Recall the discussion of the Revenue and Expenditure Report limitations in Chapter II. A link to the worksheet provided by the Department of Mental Health for documenting FSP expenditures by program for FY 08-09 is provided in Appendix E. There was no change to the original FY 09-10 RER form issued to counties. The revised 168 version, however, requires only a summary total for FSP services and does not ask for breakout expenditures. The initial questions posed about the FSP worksheets (summarized in Chapter II) laid the groundwork for similar questions about FSP services: 1. Are FSP services identified by a unique identification number in the Revenue and Expenditure Reports? a. If yes, can this be tracked to individual client (services received) in the DCR? 2. Are FSP services identified by name in the Revenue and Expenditure Report? a. If yes, can this be tracked to individual client (services received) in the DCR? b. If yes, can this be tracked to the CSS Plan and Annual Updates? The answer to #1 was determined to be no. This posed obvious problems – the most troubling being: How can we reliably link a particular FSP worksheet with expenditures to a particular age group in the DCR? An alternative was considered – perhaps FSP services as identified in the RER worksheets could be tracked to the CSS Plan and Annual Updates. The team therefore embarked upon an exhaustive review process of attempting to match every RER worksheet back to a named FSP service in the original CSS Plan, and then to subsequent fiscal year Annual Updates. The results were problematic for a number of reasons: Names change from year to year in some counties but do not always change on the RER (or vice versa); Services may be combined in a given fiscal year when they were broken out by age the previous year. For example, all small counties combined FSP breakout services by age group into one omnibus FSP service package in FY 09-10; Services disappear out of the RER but are not documented as to why they disappear in the Annual Update; New services appear in the RER, but they are not documented in the original CSS Plan or the Annual Update; Services are identified as FSP in the original CSS Plan/Annual Update, but no FSP expenditures appear in the RER; 167 Revenue and Expenditure Reports reviewed were those submitted by counties and municipalities to DMH as of October 1, 2011. Dr. Harris traveled to Sacramento and personally picked up an encrypted hard drive containing DCR data, Annual Updates and FY 08-09 and FY 09-10 RERs (UCLA already had FY 08-09 RERs from the Phase II Deliverable 1 analysis). 168 Revised instructions were issued to counties on December 27, 2011, with a due date of January 31, 2012, for counties that had not yet submitted FY 08-09 and FY 09-10 RERs. FY 09-10 is provided in the report, but the revised forms are identical to FY 08-09. http://www.dmh.ca.gov/dmhdocs/docs/notices11/11-16.pdf Although the revised instructions did not impact UCLA’s time line (FY 09-10 RERs provided by DMH were provided prior to the revised instructions issuance), the Evaluation Advisory Group will need to carefully consider whether this RER data can be used, given how different the instructions are from those of previous years. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 52 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Not all age groups that had been planned to be served may, in actuality, be served (when DCR data are compared with planned budgets); and Target age groups may change from year to year. The answer to the question, “Are FSP services identified by name in the Revenue and Expenditure Report, and can they be tracked to individual FSPs in the DCR, and to the CSS Plan and Annual Updates?” is: “It depends entirely on the county, the fiscal year and even the service in question.” In addition, the answer to the question changes even within a given county, and within a single fiscal year. However, barriers to extracting FSP expenditures by age group should not be seen as a poor reflection of county documentation. Indeed, the Revenue and Expenditure Reports were not designed for this purpose. Counties reported during the web survey process (additional data collection used for this deliverable, described later in this chapter) that they complied as best they could with the RER instructions provided, but that the RERs are not a reflection of county mental health accounting practices. Indeed, the prevailing sentiment among county fiscal staff may be summarized in one quote received: “We simply don’t track our mental health spending this way.” After spending 60 days of investigation, thoroughly exhausting these possibilities as potential data sources, the Evaluation Advisory Group was convened in order to seek expert guidance and input into resolution of the critical challenge of breaking out FSP expenditures into age groups in a reliable and valid manner. The objectives of the first Evaluation Advisory Group meeting (held November 3, 2011 – see Chapter II for an introduction to the EAG) were: a) To define the product necessary to meet the requirements of the deliverable; b) To identify feasible ways in which the deliverable may be improved (e.g., be made more informative and useful in understanding what drives expenditures per client and expenditure differences across counties); c) To identify issues and solutions to the issues that need to be resolved to: 1. identify the data elements necessary to the desired products; 2. identify the data sources most suitable to producing these data elements; 3. identify issues and solutions concerning the exact configuration of data elements (e.g., the exact definition of what FSP expenditures should include) appropriate to developing the products; 4. conduct the analysis; 5. display findings; and d) To suggest an organized set of steps to systematically resolve issues identified under c). The results of the RER analysis were presented to the Evaluation Advisory Group, along with other potential data sources. Challenges associated with each potential data source are summarized in the report, Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Emotional Disturbance and Adults and Older Adults with Severe Mental Illness, and will not be repeated here. 169 The EAG determined, during the deliberation process, that the critical question of FSP expenditures by age group would be difficult for UCLA to answer using the available data sources. Although the total expenditures on Full 169 http://mhsoac.ca.gov/Meetings/docs/Meetings/2012/Nov/OAC_111512_Tab4_MHSA_CostOffset_Report_FSP.pdf Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 53 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Service Partnerships each fiscal year can be obtained from the RER (and indeed, was obtained and reported in Phase II Deliverable 1 for FY 08-09), the RER falls short on its own in terms of providing a reliable and valid mechanism for breaking out the total expenditures by age group. Therefore, the absolute necessity of breaking out FSP expenditures by age group formed the basis for launching a county web survey. The Evaluation Advisory Group determined that only county department of mental health staff (preferably, fiscal staff) have the information needed to make determinations about how the total FSP expenditures for their county should be broken out by age group. Although a county survey represented a data collection burden, county-informed breakouts were deemed to be far preferable to any educated guess on the part of the UCLA team. Estimating expenditures for comparable services provides the foundation for assessing the return on the FSP service investment. The assessment of cost offset is accomplished through identifying how service expenditures result in substantial savings to the system (e.g., reduced hospitalization costs, reduced incarceration costs). The web survey was necessary to augment data already gathered from RERs; to ensure that all counties are adequately represented in the analysis; and to ensure the most accurate and feasible estimate of appropriate service expenditures. 1. Full Service Partnership Expenditures The total amount expended on Full Service Partnerships in FY 08-09 and FY 09-10 (as reported by each county in its RER) served as the basis for the total Full Service Partnership Expenditures. 170 Total Full Service Partnership Expenditures was only a starting point, however, given the need to break out expenditures by age group. 2. Age Groups In order to include a county in the FSP Expenditures and Cost Offsets Report, we needed Full Service Partnership expenditures broken out by age group. Per the California Code of Regulations, “The County shall provide services to all age groups i.e., older adults, adults, transition age youth, and children/youth in the Full Service Partnership 171 Service Category.” Age groups are defined as follows: “Children and youth” means individuals from birth through 17 years of age. 172 173 “Transition Age Youth” means youth 16 years to 25 years of age. 170 Three study counties did not submit an FY 09-10 RER. Therefore, expenditures as reported in the web survey served as the sole source for FSP FY 09-10 expenditures. 171 Alignment of plan, update, RER, plus breakout of discrete FSP programs into distinct age groups was a rarity among the counties, but this should not be viewed as a “negative” on the part of the counties, because the original intent of the RER had nothing to do with breakouts by age group. Note that one county was in start-up during the entire study period, and was therefore removed from the total N for purpose of this study. No comparable data was available for analysis – this is the reason for removal. Therefore, the N = 58 (rather than 59). California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3620. Full Service Partnership Service Category. Subsection (j). 172 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions. 3200.030. Children and Youth: (1) Individuals age 18 and older who meet the conditions specified in Chapter 26.5 (commencing with Section 7570) of Division 7 of Title 1 of the Government Code are considered children and youth who are eligible to receive services. 173 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.280. Transition Age Youth. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 54 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 174 “Adult” means an individual 18 years of age through 59 years of age. 175 “Older Adult” means an individual 60 years of age and older. Accordingly, all findings for this analysis are reported separately by age group. The county web survey contained questions about the proportion of expenditures on Full Service Partnership services for each age group, for each fiscal year. 176 3. Housing There was consensus among Evaluation Advisory Group members that housing is a critical aspect of FSP services, and an expensive service. 177 Housing was therefore included as an FSP expenditure even though it is reported somewhat differently in some counties. Housing, for the purpose of this study, is defined as: 178 1) Project-Based Housing Program, per California Code of Regulation (Barclays Official), Title 9. Rehabilitative and Developmental Services, Division 1. Department of Mental Health, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3630.05. Project-Based Housing Program. a) The County may use General System Development funds for costs associated with Project-Based Housing, including but not limited to: 1) Purchasing/renovating/constructing Project-Based Housing. 2) Master leasing of Project-Based Housing. (A) The lease between the County and the property owner shall specify that the County shall select the tenants and collect payments from the tenants for the Project-Based Housing. 3) Repairing damage to the Project-Based Housing in which a tenant resides/resided. 179 4) Establishing and maintaining a Capitalized Operating Subsidy Reserve. 5) Establishing a Project-Based Housing Fund. 174 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.010. Adult. 175 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.230. Older Adult. 176 Assignment of FSPs into age group categories is done at the county level. This categorization is reflected in the DCR. The UCLA team does not make any assignment of individual FSPs to age group category. 177 This does not include the Governor’s Housing Initiative. There was consensus among EAG members that this cost would be excluded from the analysis. 178 Housing, for the purpose of this study, is defined as: 1) Project-Based Housing Program, per California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3630.05. Project-Based Housing Program. Per Subsection (a): The County may use General System Development funds for costs associated with Project-Based Housing… 2) Mental Health Services Act Housing Program Service Category, per California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.225. Mental Health Services Act Housing Program Service Category. “Mental Health Services Act Housing Program Service Category” means the service category of the Community Services and Supports component of the Three-Year Program and Expenditure Plans under which Mental Health Services Act funds, administered through the California Housing Finance Agency, are used to acquire, rehabilitate, or construct permanent supportive housing for clients with serious mental illness and provide operating subsidies. 179 As defined in section 3200.028. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 55 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Mental Health Services Act Housing Program Service Category, per California Code of Regulation (Barclays Official), Title 9. Rehabilitative and Developmental Services, Division 1. Department of Mental Health, Chapter 14, Mental Health Services Act. Article 2. Definitions, 3200.225. Mental Health Services Act Housing Program Service Category. “Mental Health Services Act Housing Program Service Category” means the service category of the Community Services and Supports component of the Three-Year Program and Expenditure Plans under which Mental Health Services Act funds, administered through the California Housing Finance Agency, are used to acquire, rehabilitate, or construct permanent supportive housing for clients with serious mental illness and provide operating subsidies. Breakout Reporting of Housing Costs Since housing is a core service for stabilizing clients, and is a major cost item, the EAG recommended that housing expenditures be broken out, presented and discussed as a key expenditure. Counties were explicitly queried about the line item in which housing was reported on the RER. If it was reported on an FSP line item, the housing amount reported for the relevant age group (i.e., the age group for which housing is documented on an FSP line item) was subtracted from the FSP program expenditure total for that age group. 180 FSP expenditure by age-group calculations using RER and web survey data were included as a worksheet in each county’s FSP Expenditures and Cost Offsets Excel file, provided to counties for initial review in May 2012. 4. Outreach The EAG agreed that outreach in order to recruit individuals and families into FSP programs is another critical aspect that should be represented in expenditures, though it may be reported outside the FSP RER worksheet. There is a specific line item for Outreach in the CSS Program Worksheet, and counties may show outreach expenditures there (see Appendix E). For counties that show no expenditures under the outreach line item on their FSP program expenditure worksheets, these expenditures may be reported elsewhere. The web survey therefore contained specific questions about the cost of outreach for each fiscal year (specific to bringing potential FSP clients into service) and the proportion spent on each age group. Counties that participated in the web survey reviewed the initial draft of FSP Expenditures and Cost Offsets in a county-specific Excel file, distributed in May 2012. 181 The initial round of survey participants included a majority of the counties (N = 37; 63.8%). The populations of counties represented in the draft report for FY 09-10 comprised most of the State of California (67.3%). 182 The majority was also represented for FY 08-09 (66.9%). Although the original intent to include outreach expenditures represented the desire to document all that Full Service Partnership participants may receive, when counties reviewed the figures, consensus was that inclusion of 180 Without this adjustment, we would be counting housing expenditures twice – they are already included in the RER total, and then we would be counting them again from the county web survey (for those counties that document housing expenditures on a line item within FSP). 181 Note that one county did not provide data, and later informed the UCLA team that they were in start-up during the entire study period. This county was consequently removed from the total N for purpose of calculation. Therefore, the N = 58 (rather than 59). 182 See Appendix D for a list of county participants. Population data were extracted by county and for the state, for 2008 (corresponding to FY 08-09) and 2009 (corresponding to FY 09-10), from census data: http://www.census.gov/popest/research/eval-estimates/eval-est2010.html Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 56 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets outreach expenditures overinflated Full Service Partnership expenditures. In addition, counties indicated that drilling down on the exact outlay of outreach expenditures for FSP clients was difficult, when outreach is typically provided to a much broader population (across ages, in some cases). Given concerns about inexactitude and over-inflation of expenditures, outreach expenditures were removed from the calculations based on county feedback. 5. Operational Definitions Through the process described in this chapter, counties were queried directly about the proportion of expenditures provided to each age group for Fiscal Years 08-09 and 09-10. The proportion 183 by age group was then applied to expenditure data 184 in order to arrive at Full Service Partnership expenditures per age group. 185 This process was followed for all counties in order to maintain uniformity and in order to rely upon county- 186 informed breakouts. The definition of annual expenditure average for each age group, in each fiscal year, in each county is: Aggregated FSP Service Expenditures per Age Group Standardized Client Years per Age Group “Aggregated FSP Service” refers to the summary of all services operating within a county for each particular age group. This is the manner in which expenditures are rolled up and reported on the FSP RER worksheet. “Expenditures” for a given fiscal year is defined as the aggregate expenditure for all FSP services provided to an age group, determined using the most recent revision of the Revenue and Expenditure (RER) report for a given fiscal year that has been prepared by the county, in combination with information from that county via web survey that provides a determination as to how FSP service expenditures should be broken out into age groups. FSP service expenditures may be adjusted by housing that may be reported outside the FSP program expenditure sheets in some counties (e.g., on the CSS General System Development worksheet). 183 A small number of counties did not answer all questions, or did not answer for all age groups. For these counties, discrepancies were noted on the county-specific matrix (e.g., no expenditure data for a specific age group, but there are data for that age group in the DCR). For counties that did not answer the question about the age breakout for supportive services, the original budget/Annual Update age breakouts were used to estimate the proportion of expenditures by age group (applied to the Revenue and Expenditure Report data). If the original budget/Annual Update numbers were unclear/not specific, the actual numbers served by age group in each fiscal year were used as the basis for developing proportions by age group. The county’s FSP expenditures by age group were then submitted to the county for review and input. 184 Counties were asked to report on the amount expended per age group on supportive services provided to Full Service Partnership participants by age group. Some counties accounted for all of their FSP expenditures using this method (verified by matching back to their Revenue and Expenditure Report). Other counties accounted for only a proportion. For counties that did not account for all Full Service Partnership line-item expenditures in the web survey, the expenditures used for calculations defaulted to the Full Service Partnership line items in the county’s Revenue and Expenditure Report. 185 Not all counties serve all age groups, but the calculation for these counties was simple. For example, County X indicates that nothing was spent on Older Adults during FY 08-09. Zero proportion of expenditures is multiplied by the total FSP expenditure amount, for a total cost of $0. The value $0 is reflected on County X’s FSP Expenditures and Cost Offsets Excel spreadsheet. 186 There are a few anomalies – counties that show no expenditures on a certain age group yet show DCR data for this age group. In cases such as these, the anomaly is noted on the county worksheet, and counties were provided another opportunity for review and feedback following distribution of revised FSP Expenditures and Cost Offsets Excel worksheets on July 27, 2012. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 57 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets “Standardized Client Years” is defined as the number of full FSP client years of service provided across all programs regardless of numbers of clients entering or exiting, or the individual duration of services. This particular aspect of the calculation is discussed in more detail below (see 7. Standardized Client Years for further discussion). 6. Expenditure Calculations The proposed data sources and procedures to meet the basic requirement of calculating the annualized number of clients and FSP program expenditures per age group are described in this section. Numerator The numerator is the Aggregated FSP Expenditure per Age Group. The data source was the Revenue and Expenditure Report, cumulative across FSP services. Expenditures were limited to those reported for FSP clients, using funding sources identified in the RER program summaries combined with information provided by counties via the web survey. Denominator The denominator is the Standardized Client Years per Age Group. The data source was FSP clients as identified in the State Department of Mental Health’s Data Collection and Reporting System (DCR). The DCR was briefly introduced in Chapter II, Involvement of Key Stakeholders. The following description comes from Phase II Deliverable 2.E (draft, p. 8): The DCR system houses data for clients who are served through Full Service Partnership programs. Data from assessments – the Partnership Assessment Form (PAF), Key Event Tracking (KET) and Quarterly Assessment (3M) – are collected for clients in specific age categories. - The PAF reflects client history and baseline information, including client education and/or employment, housing situation, legal issues, health status and substance use. - The KET reflects any important changes in the client’s life such as housing, education and/or employment and legal issues during Full Service Partnership. - The 3M is used to collect information quarterly on key areas such as education, health status, substance use and legal issues. See Standardized Client Years for further discussion. Fiscal Years Analyzed The two fiscal years (FY) selected for analysis were FY 08-09 and FY 09-10. These two years were selected as a result of available data in the DCR. Without DCR data for most of the counties, Standardized Client Years per Age Group cannot be calculated (see Exhibit IV.1 for a summary of the available data sources and their limitations). 187 Data from earlier fiscal years are incomplete across California counties. The rationale for the focus on later implementation years is that no statewide assumptions can be made in earlier fiscal years. 187 See Mental Health Services Act Evaluation: Compiling Community Services and Supports (CSS) Data to Produce All Priority Indicators Contract Deliverable 2F, Phase II, available for download at: http://www.mhsoac.ca.gov/Evaluations/docs/CompilingCSSDataToProducePriorityIndicators_2FPhase2_121812.pdf Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 58 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Start-up expenditures 188 are not included in the formula 189 because for many counties, particularly larger counties, start-up occurred in years earlier than FY 08-09, when DCR data is not available for the majority of counties. The focus of our study were two fiscal years in which good quality RER and DCR data were available for the majority of counties. FY 07-08 is not included in the formula, or in this report, because DCR data are not available for most of the counties. 7. Standardized Client Years Standardized Client Years represent a numeric value in the denominator of our annual expenditure-per-FSP-client rate calculation. Calculations are completed separately for each fiscal year and for each age group. The definition of this numeric value, and the rationale for this definition, are provided in this chapter. Standardized Client Years are calculated through the following process (again, note that this process is run separately for each fiscal year and for each age group): Identified all clients who were enrolled in FSP during the target fiscal year; Calculated the number of days that each was enrolled during the target fiscal year (see the discussion below, as there are nuances to this particular calculation); Summed number of days enrolled across all enrollees; Divided by 365 (the number of days in a year). Enrollment is defined as the period of time that an individual is enrolled in and eligible for services in FSP. This definition is not dependent on being enrolled in any specific service or on receiving any specific support. The main assumption is that enrolled participants are receiving FSP services to meet their varying needs at a level that will help them achieve individualized service plan goals. These targets and the services received by individual participants will appropriately vary. Enrollment appropriate to this definition was initially defined by the partnership start and partnership status change dates entered in the Partnership Assessment Form (PAF). 190 As has been the case with most MHSA data, however, realities of the data resulted in alternative strategies, described below under Challenges. The primary concept that we measured was the number of persons served during each fiscal year (by age group). Of course, not everyone is enrolled continuously over an entire year. There are four participation patterns that needed to be accounted for in our analysis (refer back to the second bullet point, above). We present them in each fiscal year, in order to avoid any confusion that calculations may have somehow been different for different fiscal years: Fiscal Year 08-09: 191 Start date in FY 08-09 and end date in FY 08-09 188 In addition, external shocks to system (realignment and the end of AB 2034) occurred in earlier fiscal years, calling into question the ability to replicate the cost calculation into other fiscal years had earlier years been included in the analysis. Counties also provided evidence that RER instructions changed significantly from FY 06-07 to FY 07-08. Documentation may be provided, upon request. 189 Start-up for each individual county is defined as the first two years of FSP expenditures. Therefore, the actual fiscal years vary, depending upon the county. 190 The Partnership Status Change date on the PAF is updated automatically when there is a change in status on the KET or 3M. 191 We account for FSP clients with multiple start and stop dates within the same fiscal year. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 59 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Start date before FY 08-09 and end date in FY 08-09 Start date in FY 08-09 and no end date (still enrolled) Start date before FY 08-09 and no end date (still enrolled) Fiscal Year 09-10: 192 Start date in FY 09-10 and end date in FY 09-10 Start date before FY 09-10 and end date in FY 09-10 Start date in FY 09-10 and no end date (still enrolled) Start date before FY 09-10 and no end date (still enrolled) Examples are provided on the following page to illustrate the number of days calculated in each of the four categories. Here are some examples to illustrate start and end dates within the same fiscal year (FY 08-09): Sample Client Start Date in FY 08-09 End Date in FY 08-09 # of Days 001 7/3/2008 1/30/2009 211 002 7/17/2008 5/1/2009 288 003 8/26/2008 12/15/2008 111 Here are some examples that show start dates before the fiscal year and end dates within the fiscal year (FY 08- 09): Sample Client Start Date before FY 08-09 End Date in FY 08-09 # of Days 066 7/3/2007 7/15/2008 378 067 7/17/2007 7/15/2008 364 068 8/26/2007 8/22/2008 362 Below is an example of a start date within the fiscal year but no end date. (FY 09-10). When there is no end date, the end date defaults to the end of the most recent fiscal year (June 30, 2012). Sample Client Start Date in FY 09-10 No End Date # of Days 100 7/1/2009 6/30/2012 1,094 Below is one example of a start date before the fiscal year, but no end date (FY 09-10). When there is no end date, the end date defaults to the end of the most recent fiscal year (June 30, 2012). Sample Client Start Date before FY 09-10 No End Date # of Days 045 7/1/2008 6/30/2012 1,459 The examples above (number of days) are building blocks used in calculation of Standardized Client Years. 193 However, they do not represent the completion of the calculations, because they have not yet been tallied across 192 For consistency’s sake, we account for FSP clients with multiple start and stop dates within the same fiscal year. 193 Keep in mind that the primary concept is to measure the number of persons served by FSP in each fiscal year. This is very different from the number of new enrollees each fiscal year. In Chapter V, we explain why this difference is so important when we discuss cost offsets. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 60 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets all FSP clients in the age group in the fiscal year of interest, nor has the divisor of 365 been applied. The tables merely illustrate how calculations as described under the bolded bullet point are completed: Identified all clients who were enrolled in FSP during the target fiscal year; Calculated the number of days that each was enrolled during the target fiscal year; Summed number of days enrolled across all enrollees; Divided by 365 (the number of days in a year). For the purpose of discussing FSP expenditures by age group, we are interested in the number of FSP clients within each age group who received services from the FSP program in each fiscal year. It doesn’t matter if some of these people are the same people in FY 08-09 and FY 09-10. The important consideration is, did they receive FSP services in that fiscal year? If the answer is yes, then we counted them. How we counted and arrived at our final calculations is described below. Challenges Through discussion with several counties after review of their draft FSP Expenditures and Cost Offsets Excel worksheets, one issue that came to the fore was the variation across counties in number of FSP clients served in each fiscal year. This feedback prompted further investigation of FSP clients identified as being served in each FY. In reviewing DCR data for FY 08-09 and 09-10, we found cases with (the terms in quotation marks represent actual DCR variable names): Identical start (“PartnershipDate”) and change (“DatePartnershipStatusChange”) dates o Many cases are enrollees prior to FY 09-10 – which suggests that this anomaly is not due to clients recently entered into the system, A “PartnershipStatus” of “1” (indicating an active partner), and KET assessment dates subsequent to their “DatePartnershipStatusChange” – meaning that KET data were entered after the date of partnership status change, and somehow the DCR did not recognize that KET data were entered and update the DatePartnershipStatusChange variable (see example case below). Subsequent KET assessments (KETs occurring after the original PAF) suggest that a change date equal to the start date (“DatePartnershipStatusChange”) for such cases is not accurate. The inaccuracy of these end dates prevented them from being included in our initial counts. 194 The names across the table headers represent DCR variable names. The data shown below were extracted from an actual case out of the DCR to provide an example. The global identification number has been removed to protect confidentiality. GlobalID PartnershipStatus PartnershipDate DatePartnershipStatusChange AssessmentDate_KET AssessmentDate_KET AssessmentDate_KET xxxxxx 1 16-Mar-2007 16-Mar-2007 01-Oct-2009 16-Oct-2009 03-Dec-2009 In brief, the example above suggests that an FSP participant was discharged on the same day he or she was enrolled, yet the KET date clearly tells us that this is clearly not the case. This problem with the DCR system prevented cases such as these from being identified initially, given that our initial assumption was to use: 194 A separate issue that should be followed up with DMH is why DatePartnershipStatusChange is not automatically updated when KET is entered for these cases. This system glitch is troubling. 194 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 61 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets “PartnershipDate” for the date of enrollment; and “DatePartnershipStatusChange” for the date of FSP conclusion Other, related, problems were identified in the DCR data: Start (“PartnershipDate”) and change (“DatePartnershipStatusChange”) dates prior to the FY being considered, “PartnershipStatus” of “1” (indicating an active partner) or “3” (indicating a re-enrollee), and Subsequent KET assessments (in the current fiscal year – yet the CHANGE date is in a fiscal year prior to the fiscal years we are analyzing) Again, these subsequent KET assessments (dates in the fiscal years we are interested in analyzing) suggest that change dates (“DatePartnershipStatusChange”) in prior fiscal years, outside of our analysis range, are not accurate. Thus, the inaccuracy of these change dates prevented them from being included in our initial counts. The intricacies of the DCR system identified above also impact calculations of days of service. Given the anomalies uncovered, we came to the determination that the “PartnershipDate,” “DatePartnershipStatusChange” and “PartnershipStatus” fields are required for accurate estimation of the number of service days each partner received during a given FY. Decision rules regarding interpretation of the values contained in these data fields are required so that days of service can be consistently calculated for all FSP clients served in a given FY. Decision rules for FSP clients based upon their partnership status are outlined below: For active partners (i.e., “PartnershipStatus” = 1 or 3), days of service were counted from FSP start date (“PartnershipDate”) or the beginning of the given FY (July 1 for Partnership Dates prior to the FY) to the end of the FY (June 30). o Some active partners show identical “PartnershipDate” and “DatePartnershipStatusChange” and have KET assessments on the same date, within a given FY. For such cases, days of service were counted from “PartnershipDate” to the end of the given FY, as there is no indication of service end. o Active partners with “PartnershipDate” and “DatePartnershipStatusChange” prior to the FY, some with subsequent KET assessments, other without subsequent assessments. Such cases were credited with a full FY of service (365 days), as these partners are active and have no indication of service end. For non-active partners (i.e., PartnershipStatus = 0) with “DatePartnershipStatusChange” within the FY or subsequent to the end of the given FY, days of service were counted from start date (“PartnershipDate”) or the beginning of the given FY (July 1 for partnership dates prior to the FY) to a “DatePartnershipStatusChange” within the FY or the end of the FY (June 30). o Some non-active partners also show identical “PartnershipDate” and “DatePartnershipStatusChange,” and have KET assessments on the same date, within a given FY. These cases were defaulted to a single day of service. Specific decision rules regarding the values (i.e., dates and partnership status) contained in these data files were required to produce accurate counts of service days for all FSP clients served in a given FY. These decision rules were outlined in order to provide the most conservative counts of service days per FSP client. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 62 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets b. Per-Person Annualized Cost Average by Age Group Almost all of the counties are included in this Final Report (N = 50; 86.2%). 195 The populations of counties (numbers of persons residing in the counties according to census data) represented in this report comprise almost all of the State of California (95.0%). 196 The calculations shown in Tables IV.1 and IV.3 below use annualized expenditure per FSP client year as a standard metric for service expenditures across counties. The calculation of annualized expenditure per FSP client involved the following steps (recall from earlier in the chapter): Identified all clients who were enrolled in FSP during the target fiscal year; Calculated the number of days that each was enrolled during the target fiscal year; Summed number of days enrolled across all enrollees; Divided by 365. This calculation produces the number of FSP client years of service for the year. Service expenditures for the year divided by FSP client years of service for the year equals the Annualized Expenditure per FSP client year for that fiscal year. Here is the formula for annualized expenditure per FSP: FSP Expenditures Total Number of Client Years 197 This quotient was calculated within client age categories, for each fiscal year (FY 08-09 and FY 09-10). Table IV.1 Full Service Partnership Services: Numbers Served by Age Group (Fiscal Year 08-09) Number Served Sum of Days Number of Client Years Age Group Total Low High Total Low High Total Low High CYF 4,296 9 2,223 983,187 1,369 580,545 2,693.7 3.8 1,590.5 TAY 4,593 25 1,257 1,064,015 6,517 333,383 2,915.1 17.9 913.4 Adults 9,640 37 4,176 2,404,022 9,000 1,148,521 6,586.4 24.7 3,146.6 Older Adults 1,388 1 373 344,979 7 98,535 945.1 <.1 270.0 195 Calculations were successfully completed for three additional counties that did not complete the web survey. These three counties aligned their CSS Plans, Annual Updates, and Revenue and Expenditure Reports in a consistent manner and broke out FSP programs into discrete age groups. Alignment of plan, update, RER, plus breakout of discrete FSP programs into distinct age groups was a rarity among the counties, but this should not be viewed as a “negative” on the part of the counties, because the original intent of the RER had nothing to do with breakouts by age group. Inclusion of the three additional counties brings the total number of participants to 50 (86.2%). Note that one county was in start-up during the entire study period, and was therefore removed from the total N for purpose of calculation. Therefore, the N = 58 (rather than 59). The link to census data is: http://www.census.gov/popest/research/eval-estimates/eval-est2010.html 196 See Appendix D for a list of county participants. 197 Small counties have been pooled for the purpose of presenting data in Tables IV.1 and IV.2. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 63 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table IV.2 Full Service Partnership Services: Annualized Expenditure per-Client by Age Group (Fiscal Year 08-09) Annualized Expenditure per- FSP Client Daily Expenditure per-FSP FSP Service Expenditure Total Client Age Group Average Low High Average Low High Total Low High CYF $21,931.29 $3,759.79 $72,054.99 $60.09 $10.30 $197.41 $59,076,305.79 $86,851.14 $27,863,702.00 TAY $18,553.96 $6,753.44 $92,470.00 $50.83 $18.50 $253.34 $54,086,655.41 $352,529.77 $21,698,945.60 Adults $26,737.23 $6,815.18 $64,318.98 $73.25 $18.67 $176.22 $176,102,066.30 $254,338.00 $81,947,433.40 Older Adults $22,303.26 $14,593.75 $112,063.43 $61.10 $41.06 $307.02 $21,078,807.79 $64,976.01 $5,720,395.00 Annualized expenditure is the total expenditure for an FSP client over a year (12 months). Tables IV.3 and IV.4 display the same type of information about numbers served and expenditures as in Tables IV.1 198 and IV.2, but for Fiscal Year 09-10. Table IV.3 Full Service Partnership Services: Numbers Served by Age Group (Fiscal Year 09-10) Number Served Sum of Days Number of Client Years Age Group Total Low High Total Low High Total Low High CYF 6,348 5 3,165 1,444,331 780 820,496 3,957.1 2.1 2,247.9 TAY 6,623 36 1,702 1,619,816 8,444 477,643 4,437.9 23.1 1,308.6 Adults 12,733 39 4,541 3,456,407 3,630 1,357,732 9,469.6 9.9 3,719.8 Older Adults 1,764 1 406 480,383 365 124,740 1,316.1 1 341.8 Table IV.4 Full Service Partnership Services: Annualized Expenditure per-Client by Age Group (Fiscal Year 09-10) Annualized Expenditure per- FSP Daily Expenditure per-FSP FSP Service Expenditure Total Client Client Age Group Average Low High Average Low High Total Low High CYF $17,481.79 $3,933.95 $54,663.66 $47.90 $10.78 $149.76 $69,177,192.53 $82,641.89 $40,675,886.00 TAY $13,741.40 $5,584.11 $54,570.82 $37.65 $15.30 $129.51 $60,982,974.12 $287,581.77 $22,853,881.40 Adults $23,626.13 $5,066.28 $55,558.11 $64.73 $13.88 $261.41 $223,729,986.45 $320,491.79 $113,766,228.00 Older Adults $18,785.22 $9,538.23 $162,106.00 $51.47 $26.13 $141.99 $24,723,227.99 $43,553.21 $6,412,015.00 The age breakouts reveal that FSP services for Adults comprise most of the expenditures in both fiscal years. c. Contextual Factors – Relationship to Expenditures FY 09-10 was chosen to conduct additional analyses in order to examine the potential relationship between contextual factors and expenditures. FY 09-10 was selected because the number of counties included in the analysis was larger than for FY 08-09. When comparing per-FSP expenditures between FY 08-09 and FY 09-10, wide variation was observed for some small counties. When variation exceeded a pre-established threshold, FY 08-09 was excluded from report analyses. However, setting aside a number of small counties should not be viewed as a poor reflection of FSP implementation by these counties. Indeed, the likely reason for variation is documented in the California Code of Regulations: 198 Small counties have been pooled for the purpose of presenting data in Tables IV.3 and IV.4. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 64 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Small counties proposing to provide full service partnership programs/services in Fiscal Year 2008-09 must only identify the population to be served and the amount of funding to be 199 reserved for this purpose. See Appendix D, which lists the small counties for which FY 08-09 was not included in the FY 08-09 analysis. Table IV.5 displays information about possible factors of service populations, the kinds of services provided by counties, and characteristics of the counties themselves that may be related to differences between the average county FSP expenditure per client. These county-level factors were subsequently analyzed using multivariate statistics in order to determine the relationship to the average FSP expenditure in each county. Hence, the purpose was comparison of county-level variables (not individual-level variables). Table IV.5 Description of County-Level Variables - Total FSP Average Daily Expenditure per County CYF Average TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure The number of counties for which we have daily expenditure data. An average Number of Counties for each age group was calculated, in order to produce a county-level variable, to compare with other county-level variables. The total number of FSP activities/strategies offered in the county (see Number of Service Options Appendix B). The total number of FSP evidence-based activities/strategies offered in Evidence-Based Services the county (see Appendix B). The total number of FSP activities/strategies led by peers in the county Peer Services (see Appendix B). The Penetration Rate is a ratio estimate of the prevalence of serious Penetration Rate mental illness/serious emotional disturbance in California (developed by Dr. Charles Holzer from the University of Texas). Population density was created for each county using county population and Population Density square miles of the county. Percent County Population Insured Percent of county population with health insurance. 2009 Poverty and Median Income Estimates – Counties; Poverty Level Source: U.S. Census Bureau, Small Area Estimates Branch The California Employment Development Department (CA EDD) defines Unemployment Rate “Unemployment Rate” as the number of unemployed divided by the labor force then multiplied by 100. Rate of Foreclosures Rate of foreclosures in the county. A series of multivariate analyses were conducted in order to determine the relationship between average expenditure by age group and county factors. Analyses completed included: Regression General Linear Model ANOVA MANCOVA 199 California Code of Regulation (Barclays Official), Title 9, Division 1, Chapter 14, Mental Health Services Act. Article 6. Community Services and Supports, 3650. Community Services and Supports Component of the Three-Year Program and Expenditure Plan. Scroll down to (6) (F) for the discussion of small counties in FY 08-09. The instructions continue…Prior to implementation, detailed work plans, time frames, budgets and staffing requirements for each Full Service Partnership program to ensure review and requirements will be required for each Full Service Partnership program to ensure review and approval by the Department and the Oversight and Accountability Commission (OAC), as appropriate. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 65 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets None of the multivariate models yielded meaningful results, resulting in return to examining the correlational matrices produced during the process of conducting multivariate analyses. The results are displayed in Table IV.6. Table IV.6 provides information on possible factors of service populations, the kinds of services provided by counties, and characteristics of the counties themselves that may be related to differences between the average county FSP expenditure per age group. Table IV.6 displays correlations between select characteristics of services provided (number of service options offered in the county, number of evidence-based options, number of peer led services offered); and characteristics of the county environment (penetration rate, 200 population density, 201 percent of county population with health insurance, 202 poverty level, 203 county unemployment rate, 204 and rate 205 of foreclosures). 200 UCLA updated the penetration rate for each county to reflect the relevant year and applicable census data, per the following notation from DMH: When considering these penetration rates, it is important to remember that they are based on census data combined with estimates that were calculated by applying prediction weights. Due to the way census data is updated, the data in the tables should be viewed as "best available" and should be checked and/verified at the local level where numbers do not appear to represent actual local population data. http://www.dmh.ca.gov/Statistics_and_Data_Analysis/RetentionPenetrationData.asp Please refer to the following report for further information about the penetration rate and its use: Mental Health Services Act Evaluation: Compiling Community Services and Supports (CSS) Data to Produce All Priority Indicators; Contract Deliverable 2F, Phase II http://www.mhsoac.ca.gov/Evaluations/docs/CompilingCSSDataToProducePriorityIndicators_2FPhase2_121812.pdf See pages 42 – 45. Cost Offsets can be developed only for counties that submit data to the State Department of Mental Health’s Full Service Partnership (FSP) Data Collection and Reporting System (DCR). All of the variables used in the FSP Cost Offset analysis are contained in the DCR. UCLA does not have access to non-DCR data from counties. 201 Population density was created for each county using county population and square miles of the county. The population of each county was taken from the following archival dataset: http://www.census.gov/popest/research/eval-estimates/eval-est2010.html Population Estimates, 2010, U.S. Census Bureau, Population Division. The square miles of each county was taken from the following archival dataset: http://quickfacts.census.gov/qfd/states/06000.html U.S. Census Bureau State and County Quick Facts. The areas analyzed for savings are very similar to those analyzed in the evaluation of AB 2034 efforts, which included inpatient psychiatric hospitalization and incarceration. Emergency room use was also evaluated but was limited to psychiatric rather than physical health. California Department of Mental Health (2007). (unpublished) Report to the Legislature on the effectiveness of integrated services for homeless adults with serious mental illness. Sacramento, CA: Author. 202 Percentage Insured - 2003, 2005, 2007, and 2009: California Health Interview Survey: http://www.chis.ucla.edu/ The areas analyzed for savings are very similar to those analyzed in the evaluation of AB 2034 efforts, which included inpatient psychiatric hospitalization and incarceration. Emergency room use was also evaluated but was limited to psychiatric rather than physical health. California Department of Mental Health (2007). (unpublished) Report to the Legislature on the effectiveness of integrated services for homeless adults with serious mental illness. Sacramento, CA: Author. 203 Poverty Rate: Table 1: 2009 Poverty and Median Income Estimates – Counties (released in December 2010); Source: U.S. Census Bureau, Small Area Estimates Branch http://www.census.gov/did/www/saipe/data/statecounty/data/2009.html 204 Unemployment - California Unemployment Rate (Average – Not Seasonally Adjusted) http://www.labormarketinfo.edd.ca.gov/?pageid=164 The California Employment Development Department (CA EDD) defines “Unemployment Rate” as the number of unemployed divided by the labor force then multiplied by 100 (http://www.labormarketinfo.edd.ca.gov/?pageid=1006). For sake of consistency in data presentation, UCLA calculated unemployment rates using the same method as CA EDD. 205 The foreclosure rate is defined as the number of foreclosed properties as a percent of households. HousingLink (2007). Fixing the foreclosure system: The trouble with foreclosure data. Retrieved August 23, 2011, from http://www.minneapolisfed.org/news_events/events/community/100407/foreclosuredata_obrien.pdf California Number of Foreclosures (Annual) were obtained from Realty Trac, and then foreclosure rates calculated using the methodology described above. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 66 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table IV.6. Correlations (Pearson’s) of FSP Services, and County Characteristics to Total FSP Average Daily Expenditures for Counties (Fiscal Year 09-10) CYF TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Number of Counties 34 39 42 31 Number of Service Options -0.120 -0.262 -0.011 -0.290 Evidence-Based Services -0.102 -0.171 0.133 -0.225 Peer Services -0.070 0.034 0.050 -0.230 Penetration Rate -0.070 -0.140 0.006 -0.156 Population Density 0.180 -0.177 0.077 -0.078 Percent County Population Insured 0.420* 0.095 -0.067 -0.164 Poverty Level -0.373* -0.208 -0.212 0.066 Unemployment Rate -0.310 0.115 -0.173 0.057 Rate of Foreclosures -0.179 0.144 -0.264 0.191 *Correlation is significant at the .05 level The results displayed in Table IV.6 highlight the: 1. relatively small degree to which these factors are associated with the average FSP daily expenditure across counties, 2. presence of only one factor that shows a consistent direction of association with the average daily FSP expenditure across all age groups (number of service options – negative correlation for each age group), CYF TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Number of Service Options -0.120 -0.262 -0.011 -0.290 and 3. degree to which other factors related to the average FSP daily expenditure differ across participant age groups (e.g., unemployment rate is negatively correlated with CYF and Adult Daily cost and positively correlated with TAY and Older Adult Daily cost. In addition, the correlation is moderate for CYF, and very small for the other age groups). CYF TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Unemployment Rate -0.310 0.115 -0.173 0.057 With respect to the relatively small magnitude of association as measured by these coefficients, two associations reach a level of statistical significance, but only for CYF expenditures (percent of county population insured and poverty level). Please note that correlation does not equal causation – association merely means that two variables are related to one another, not that one variable changed the other variable in any way: Percent of Population Insured: Higher percentages of children with insurance were correlated (at .05 significance level) with higher average daily FSP expenditure for CYF. Poverty Level: Lower percentages of families with children living in poverty were correlated (at .05 significance level) with higher average daily expenditure for CYF. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 67 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 206 In order to examine select characteristics of FSP participants (gender, race/ethnicity), additional correlational analyses were conducted. An explanation of the variables used in analysis is provided below, in Table IV.7, and the results are displayed in Table IV.8. Table IV.7. Description of FSP-Level Variables - Total FSP Average Daily Expenditure CYF Average TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Gender The proportion of Caucasian FSPs (by age group) in each county. Race The proportion of FSPs (by age group) in each county that are Male. Table IV.8. Correlations (Spearman’s Rank Order) of FSP Characteristics to FSP Average Daily Expenditures (Fiscal Year 09-10) CYF TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Number of Counties 34 39 42 31 Gender -0.175 -0.066 0.116 -0.437* Race 0.458* 0.404* 0.150 0.126 *Correlation is significant at the .05 level (2-tailed) The results displayed in Table IV.8 highlight the: 1. relatively moderate degree to which FSP characteristics are associated with the average FSP daily expenditure for some age groups across counties (compared to the county characteristic variables), CYF TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Gender -0.175 -0.066 0.116 -0.437* ← Race 0.458* 0.404* 0.150 0.126 ↑ ↑ 2. presence of one factor that shows a consistent direction of association with the average daily FSP expenditure across all age groups (race – proportion of White/Caucasian FSPs – positive correlation for each age group), and CYF TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Race 0.458* 0.404* 0.150 0.126 206 In order to create a county-level variable, the percentage of the FSP population in each county that is Caucasian was calculated. Individual- level data could not be entered into the model analyzing county-level data. For gender, the percentage of the FSP population that was male was calculated. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 68 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 3. the degree to which gender is largely unrelated to the average FSP daily expenditure, with the exception of Older Adults. CYF TAY Adult Older Adult Daily Daily Daily Daily Expenditure Expenditure Expenditure Expenditure Gender -0.175 -0.066 0.116 -0.437* ← With respect to the relatively moderate magnitude of association as measured by these coefficients, three associations reach a level of statistical significance. Please note that correlation does not equal causation – association merely means that two variables are related to one another, not that one variable changed the other variable in any way: Race/Ethnicity: Higher percentages of white (Caucasian) FSPs served by a county were associated with higher average daily FSP expenditure for CYF and TAY (at .05 significance level). Gender: Higher percentages of male (FSPs) served by a county were associated with lower average daily FSP expenditure for Older Adults (at .05 significance level). o However, when the results are depicted graphically (see Exhibit IV.3), most counties tend to cluster in the center of the distribution (mid-range of expenditures, serving a population that ranges from 30 to 50% male). Therefore, the data display does not tell a clear story, and this result is inconclusive (by way of comparison, examine Exhibits IV.1 and IV.2, in which a clearer relationship can be drawn between CYF and TAY daily expenditures and the proportion of white/Caucasians served). These results are depicted graphically in Exhibits IV.1 through IV.3. Exhibit IV.1. Relationship of CYF Race/Ethnicity to FSP Average Daily Expenditures (Fiscal Year 09-10) Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 69 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Exhibit IV.2. Relationship of TAY Race/Ethnicity to FSP Average Daily Expenditures (Fiscal Year 09-10) Exhibit IV.3. Relationship of Older Adult Gender to FSP Average Daily Expenditures (Fiscal Year 09-10) Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 70 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets d. Summary FSP expenditures per client and cost offsets vary substantially across counties. The age breakouts reveal that although FSP services for Adults comprise most of the expenditures, when participant and county characteristics were analyzed in order to determine potential association with FSP expenditures, relationships are evident for only CYF, TAY and Older Adults. The following correlations resulted (moderate range): Percent of Population Insured: Higher percentages of children with insurance were correlated with higher average daily FSP expenditure for CYF. Poverty Level: Lower percentages of families with children living in poverty were correlated with higher average daily expenditure for CYF. Race/Ethnicity: Higher percentages of white (Caucasian) FSPs served by a county were associated with higher average daily FSP expenditures for CYF and TAY The moderate relationships between FSP expenditures and county/participant characteristics suggest other factors relate to variation between counties. Additional investigation is needed in order to determine county, service and client characteristics that may impact FSP expenditures. For example, clinical diagnosis has been shown in a previous study to be an important covariate, and encounter data at the unit of service level a critical outcome variable (particularly use of outpatient services). 207 Neither variable was available for analysis given the need to rely largely upon available data sources for the current study. Fidelity to implementation of evidence-based practices and other quality of service indicators merit further investigation, given the logical relationship to outcomes. 207 Gilmer, T.P.; Stefancic, A.; Ettner, S.L.; Manning, W.G.; & Tsemberis, S. (2010). Effect of Full Service Partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness. Archives of General Psychiatry, 67, 645-652. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 71 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets V. Cost-Offsets for Full Service Partnership Programs One focus of this chapter is “whether costs incurred in providing mental health services … are offset by reduced costs elsewhere in the health care system.” 208 By virtue of the data collected at the time of intake and follow-up, we have been able to expand exploration of cost reduction beyond the health care system, to include incarceration. The report, Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Emotional Disturbance and Adults and Older Adults with Severe Mental Illness, outlines whether amounts 209 expended providing Full Service Partnership services are offset by reduced costs in: Physical Health Services 210 Acute Care Inpatient Hospitalization (number of days) Skilled Nursing (Non-Psychiatric) (number of days) Emergency Room Visits (number of times) Psychiatric Care Inpatient Psychiatric Hospitalization (number of days) 211 Long-Term Care (number of days) Skilled Nursing (Psychiatric) (number of days) Criminal Justice Involvement Arrests (number of times) Division of Juvenile Justice (number of days) Juvenile Hall/Camp (number of days) Jail (number of days) Prison (number of days) Findings in each of these areas are presented, each age group, in that report, and will not be repeated here. The detailed report summarizing statewide findings may be found at: http://mhsoac.ca.gov/Meetings/docs/Meetings/2012/Nov/OAC_111512_Tab4_MHSA_CostOffset_Report_FSP.pdf 208 Fells, T. (1999). Is there a cost offset to psychotherapy? Journal of Psychotherapy Practice and Research, 8, 243, 247. Quote taken from p. 243. 209 Cost Offsets can be developed only for counties that submit data to the State Department of Mental Health’s Full Service Partnership (FSP) Data Collection and Reporting System (DCR). All of the variables used in the FSP Cost Offset analysis are contained in the DCR. UCLA does not have access to non-DCR data from counties. The areas analyzed for savings are very similar to those analyzed in the evaluation of AB 2034 efforts, which included inpatient psychiatric hospitalization and incarceration. Emergency room use was also evaluated but was limited to psychiatric rather than physical health. California Department of Mental Health (2007). (unpublished) Report to the Legislature on the effectiveness of integrated services for homeless adults with serious mental illness. Sacramento, CA: Author. We recognize that there are fixed costs associated with each of the offset categories analyzed. The important point is that participants in the Full Service Partnership program are less likely to be the ones occupying the inpatient psychiatric bed, jail cell, etc. as a result of intervention. Obviously, the hospital bed and jail cell are still available for someone else’s use, as it were. 210 As defined in response to physical health needs – we examine psychiatric hospitalization as a separate category of offsets. 211 Institution for Mental Diseases/Mental Health Rehabilitation Centers. The KET does not distinguish between whether an FSP client’s long- term care was reimbursed at the MHRC rate or the IMD rate. Therefore, an average of the IMD and MHRC rates for the facilities contracted by each county was used as the basis for calculating the cost applied to the number of days in long-term care. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 72 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Rather, the total amount of costs offset and reasons for variation by county are the focus of this particular chapter. a. Methodology There are four formulas that are completed when calculating cost offsets (regardless of whether we are calculating offsets for physical health, psychiatric care or criminal justice). In this section (methodology), each calculation is 212 introduced and briefly described below. This section is followed by a subsection devoted to cost offset calculation, in which an in-depth, step-by-step explanation is provided. Please refer to the numbered section (corresponding to the steps as outlined below) for further explanation of the calculations. The four calculations are: 1. Out of the larger group of FSP clients new enrollees (FY 08-09 and FY 09-10) are selected. 2. For the pre-intake period (the 12 months prior to enrolling in the FSP), in each of the offset categories – o Per client:  Number of days per year/number of events per year (annual) o Annual per-client number of days/events is different from annualized per-client number of days/events, below, under #3. 3. For the post-enrollment period (the 12 months after intake in the FSP), in each of the offset categories – o Per client:  Annualized number of days/number of events o Annualized per-client number of days/number of events is different from annual per-client number of days/events, above, under #2. o Annualized per-client number of days/number of events involves application of an annualization multiplier, in order to arrive at the annualized number of days/number of events per client. The annualization multiplier is very different from a statewide rate (which is a dollar amount and is described under #4). 4. A statewide rate (e.g., cost of incarcerating an individual for one day) is applied to arrive at cost offset (and then applied to number of days of acute hospitalization, etc.) o After the number of days is multiplied by the rate:  For the pre-intake period (the 12 months prior to enrolling in the FSP), the annual per-client cost offset is produced.  For the post-enrollment period (the 12 months after intake in the FSP), the annualized per- client cost offset is produced. In this section of the report, an important distinction is drawn between expenditures and costs. In the previous chapter, the focus was on expenditures (amount expended for FSP services). In this chapter, the focus is on costs. In particular: 212 This report, succinct introduction to the Methodology section is provided for organizational purposes only (in order to provide an orientation for the reader), and will be insufficient to provide complete understanding of the methodology. Please refer to the report: Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Emotional Disturbance and Adults and Older Adults with Severe Mental Illness: http://mhsoac.ca.gov/Meetings/docs/Meetings/2012/Nov/OAC_111512_Tab4_MHSA_CostOffset_Report_FSP.pdf in which step-by-step instructions are provided for calculation of each cost offset area. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 73 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Physical Health Services Acute Care Inpatient Hospitalization – the daily cost of hospitalization (non-psychiatric) The Office of Statewide Health Planning and Development (OSHPD) is the source for the rates applied by county for acute inpatient care. 213 Among the counties that participated, a “statewide” rate was determined by calculating an average of the rates for counties that participated in this round of the study. 214 The statewide average cost for FY 08-09 is: Inpatient Hospitalization - Physical Statewide Average FY 08-09 $2,546.01 The statewide rate for FY 09-10 is: Inpatient Hospitalization - Physical Statewide Average FY 09-10 $2,676.36 The OSHPD data set 215 includes all hospitals in each county. If a county has more than one hospital providing acute hospitalization services, an average within the county was first calculated in order to arrive at a rate for each county. Below is the definition of acute care hospitalization, as provided by OSHPD. For the purpose of this report, the daily cost in each county was used in analysis. The example above is provided for illustrative purposes only, in order to highlight the difference between expenditures (an amount expended) and costs (the standard cost to provide a service – in this case, a day of inpatient hospitalization) Other physical health services analyzed for cost savings included: Skilled Nursing (Non-Psychiatric) – the daily cost of non-psychiatric skilled nursing facility care Emergency Room Visits – cost per emergency room visit See the statewide report referenced in Chapter IV for the statewide average cost in each fiscal year, and the data sources. Psychiatric Care Inpatient Psychiatric Hospitalization -- the daily cost of inpatient psychiatric hospitalization Long-Term Care – the daily cost of long-term care Skilled Nursing (Psychiatric) daily cost of psychiatric skilled nursing facility care Criminal Justice Involvement Arrests (number of times) – cost per arrest Division of Juvenile Justice (number of days) – daily cost in a Division of Juvenile Justice facility Juvenile Hall/Camp (number of days) -- daily cost in Juvenile Hall/Camp Jail (number of days) -- daily cost in Jail 213 http://www.oshpd.ca.gov/hid/Products/Hospitals/Utilization/Hospital_Utilization.html 214 See Appendix D for a list of counties that participated in the study. 215 Available for download from its website, http://www.oshpd.ca.gov/hid/Products/Hospitals/Utilization/Hospital_Utilization.html Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 74 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Prison (number of days) -- daily cost in Prison The methodology for each aspect of these new calculations is described in this section. 1. New Enrollees All cost-offset analyses were limited to new enrollees in each fiscal year. First we explain what a new enrollee is, and then we will justify why limiting the analysis to new enrollees was imperative. This new aspect of methodology for calculating cost offsets is actually part of a calculation introduced in Chapter III. Our new enrollees are the bolded groups. Recall the following: Fiscal Year 08-09 216 Start date in FY 08-09 and end date in FY 08-09 Start date before FY 08-09 and end date in FY 08-09 Start date in FY 08-09 and no end date (still enrolled) Start date before FY 08-09 and no end date (still enrolled) Fiscal Year 09-10 217 Start date in FY 09-10 and end date in FY 09-10 Start date before FY 09-10 and end date in FY 09-10 Start date in FY 09-10 and no end date (still enrolled) Start date before FY 09-10 and no end date (still enrolled) A new enrollee is identified thus: FY 08-09: Enrollment date between July 1, 2008, and June 30, 2009 FY 09-10: Enrollment date between July 1, 2009, and June 30, 2010 Any FSP client who did not meet these enrollment-date criteria was excluded from the cost-offset analysis. Enrollment date was the sole determining factor as to which fiscal year an FSP client was placed into for purpose of analysis. An FSP client appeared in only one data set (no one appeared in both fiscal years, despite the fact that an 218 FSP client who enrolled in FY 08-09 might still be enrolled in FY 09-10). It was critical to limit the cost-offset analysis to new enrollees in order to compare the proverbial apples to apples. In brief: At intake, days of hospitalization and incarceration are queried for the 12 months prior to enrollment. In order to provide a valid comparison (apples to apples), the post-comparison period had to be limited to the 12 months after enrollment. 216 We account for FSP clients with multiple start and stop dates within the same fiscal year. 217 For consistency’s sake, we account for FSP clients with multiple start and stop dates within the same fiscal year. 218 Length of participation is handled through the annualization calculation. Refer back to the discussion of methods in Chapter IV. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 75 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table V.1 displays the number of FSP clients (new enrollees only) in FY 08-09. FY 08-09 new enrollees are a subset of the larger group of clients displayed in Chapter IV. Table V.1 Full Service Partnership Services: New Enrollees by Age Group (Fiscal Year 08-09) Number of New Enrollees FY 08-09 CYF 2,164 TAY 2,327 Adults 4,315 Older Adults 582 Total 9,388 Table V.2 displays the number of FSP clients (new enrollees only) in FY 09-10. FY 09-10 new enrollees are a subset of the larger group of clients displayed in Chapter IV. Table V.2 Full Service Partnership Services: New Enrollees by Age Group (Fiscal Year 09-10) Number of New Enrollees FY 09-10 CYF 3,101 TAY 2,977 Adults 4,702 Older Adults 645 Total 11,425 2. Pre-Intake Period – 12 Months Prior to Enrolling in FSP: Annual per-Client Offset- Category Cost This concept is actually straightforward. Because the Partnership Assessment Form (PAF) contains questions for FSP clients about number of days hospitalized, etc., in the 12 months prior to enrollment, there is no need to apply an annualization formula. The period of time in question is already 12 months. PAF data are collected by individual counties, and then entered into the State of California Department of Mental Health’s Data Collection and Reporting System (DCR). UCLA received the DCR data (updated through June 30, 2011) through the contract to conduct the Statewide Evaluation of the Mental Health Services Act. Therefore, annual per-client offset-category cost is calculated for the baseline (pre-enrollment) through the following steps: 219 Identified all clients who enrolled in FSP during the target fiscal year. Through intake interview data (PAF), identified the number of days of hospitalization, incarceration, etc., 220 for each client. 219 See above for an explanation of how new enrollees were identified. 220 See the report, http://mhsoac.ca.gov/Meetings/docs/Meetings/2012/Nov/OAC_111512_Tab4_MHSA_CostOffset_Report_FSP.pdf for details. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 76 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets In the year prior to enrollment, summed across all clients, multiplied by the daily negotiated cost for the county 221 and divided by the number of clients enrolled in FSP during the target year. 222 This quotient is the annual per-client (offset-category) cost for the baseline, the year prior to enrollment. 3. Post-Intake Period – 12 Months Post-Enrollment into FSP: Annualized per-Client Offset- Category Cost The manner in which annualization is calculated has already been described (Chapter IV), and the methodology is 223 no different when applied to cost offsets. Annualized per-client (offset-category) cost is calculated for the period of time each client is in FSP following enrollment. This post-enrollment offset-category cost is calculated through the following steps: Identified all clients who enrolled in FSP during the target fiscal year (new enrollees), and the number of 224 those who had been hospitalized, incarcerated, etc. 225 Through Key Event Tracking data, identified: o The number of days enrolled. o Days Enrolled is then divided into 365 (the number of days in a year), illustrated in the formula below: 365 Days Enrolled o This quotient is the annualization multiplier for each new enrollee. o The annualization multiplier is applied to all new enrollees, whether or not they were hospitalized, incarcerated, etc. 226 Identified: o The number of days of hospitalization, incarceration, etc., for each client post-enrollment, and o Multiplied by each client’s annualization multiplier.  An example annualization multiplier from a randomly selected Adult FSP client = .62 221 See the report, http://mhsoac.ca.gov/Meetings/docs/Meetings/2012/Nov/OAC_111512_Tab4_MHSA_CostOffset_Report_FSP.pdf for details. 222 Total number of new enrollees – see Tables V.1 and V.2. 223 Annualization of the service period is the same methodology used by the California Department of Mental Health when evaluating and reporting on AB 2034 outcomes. California Department of Mental Health (2007). (unpublished) Report to the Legislature on the effectiveness of integrated services for homeless adults with serious mental illness. Sacramento, CA: Author. 224 See the report, http://mhsoac.ca.gov/Meetings/docs/Meetings/2012/Nov/OAC_111512_Tab4_MHSA_CostOffset_Report_FSP.pdf for each cost-offset category and the exact DCR variables that were used in the calculations. 225 See Chapter IV for an introduction to the KET, variables used when calculating number of days of FSP participation, and each cost-offset category in this chapter for the specific cost-offset variables used in analysis. 226 See Chapter IV for how days of enrollment were calculated. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 77 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets  New enrollees with zero (0) days (of hospitalization, for example) drop out of the analysis at this point, and we are left with those new enrollees with a number of days in the offset category of interest. o This product is the annualized number of days of (cost-offset category) for each new enrollee (e.g., who was hospitalized or incarcerated during the 12-month follow-up period).  The 12-month follow-up period is completely tailored to the individual FSP client, and entirely based upon the date of intake into the FSP. For example: Sample Client Intake (Start Date in FY 08-09) 12-Month Follow- Up Period # of Days (Follow-Up goes into FY 09-10) 251 12/1/2008 11/30/2009 365 Note that this particular FSP client is a new enrollee in FY 08-09 based on the intake date of 12/1/2008. This FSP client is not “double-counted” as a new enrollee in FY 09-10 because there is no intake date in FY 09-10. The data shown in the table above illustrate the following about the 12-month follow-up period:  The 12-month follow-up period is tied to the individual FSP client;  The 12-month clock starts ticking with the individual FSP client’s date of intake; and  The 12-month follow-up period can cross fiscal years for an individual client. 227 Summed annualized days of (cost-offset category) across all new enrollees. o Multiplied by the daily negotiated cost of psychiatric hospitalization, incarceration, etc., for the county, 228 and 229 o Divided by the number of new enrollees in FSP during the target year. This quotient is the annualized per-client hospitalization, incarceration, etc., cost for the post-enrollment period. Again, note that we limited the analyses to new enrollees in order to have a match with the 12-month pre- enrollment period, in essence, to compare the 12 months after enrollment with the 12-month period prior to enrollment (PAF question asks about the 12 months prior to enrollment when asking about hospitalization, etc.). This chapter summarizes the program costs for clients who initially enrolled in FSP during the target fiscal year, the amount of offsets, and the percentage of one-year program costs that have been saved in annualized physical health care, psychiatric care and criminal justice through FSP participation by these new enrollees. b. Costs Offset by Age Group This report identifies the cost savings that society realizes because these services have been provided. Of course, these savings are not the sole justification of expenditures; the primary purpose of the law is to improve services to mentally ill citizens most in need of assistance. However, it is a critical role of accountable and transparent public service to demonstrate the impacts of this needed and individually compassionate service on public concerns. Therefore, this analysis summarizes the savings that are incurred in a limited number of public services for the recipients of FSP services. To state this differently, this analysis assesses the costs to society with respect to 227 Note that FSP clients who do not have any days of hospitalization, incarceration, etc., have dropped out of the analysis at this point. 228 See each specific offset category in this chapter for where these rates were obtained and the manner in which they were applied. 229 Total number of new enrollees – see Tables V.1 and V.2. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 78 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets health services that are incurred by persons facing severe mental health challenges, and public costs incurred because of criminal justice system involvement attributable to these challenges. It is important to note that this is a conservative analysis. Expenditures that are not clearly attributable to FSP clients have not been included, and cost savings estimates have been indexed to conservative estimates of cost. As is widely recognized, estimating the costs of savings attributable to service is complex – from both an expenditure estimate and a benefit estimate point of view. At each step in these estimation processes, we have consciously adopted a conservative approach. See Chapter IV for discussion of the age groups and their definitions, and the number of counties included in this report. Table V.4 below represents service expenditures and costs saved for Fiscal Year (FY) 08-09 new FSP 230 enrollees. Cost offsets are the total differential between the cost of mental and physical health services, and criminal justice involvement costs in the year prior to entry into FSP services and the average 12-month cost after entry into services. 231 This is the amount of public money in these areas that was saved after these clients had access to service. Table V.3 Full Service Partnership Services: Number of New Enrollees by Age Group (Fiscal Year 08-09) Number of New Sum of Days Enrollees FY 08-09 Age Group Total Low High Total Low High CYF 2,164 9 2,223 340,323 1,369 580,545 TAY 2,327 25 1,257 371,250 6,517 333,383 Adults 4,315 37 4,176 690,298 9,000 1,148,521 Older Adults 582 1 373 91,220 7 98,535 Table V.4 Full Service Partnership Services: Expenditures and Cost Offsets by Age Group (Fiscal Year 08-09) Total Expenditures for FY 08-09 New Total Cost Offset FY 08-09 Enrollees Age Group Total Low High Total Low High CYF $20,450,009.07 $3,759.79 $72,054.99 $2,428,313.16 $86,851.14 $27,863,702.00 TAY $18,870,637.50 $6,753.44 $92,470.00 $22,437,417.44 $352,529.77 $21,698,945.60 Adults $50,564,328.50 $6,815.18 $64,318.98 $41,509,329.01 $254,338.00 $81,947,433.40 Older Adults $5,573,542.00 $14,593.75 $112,063.43 $5,421,665.55 $64,976.01 $5,720,395.00 230 See Appendix G for a display of the data shown in this table, by county. Again, note that small counties have been pooled for the purpose of display in Appendix G. 231 Please refer to the report for a complete discussion of cost offsets: Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Emotional Disturbance and Adults and Older Adults with Severe Mental Illness: http://mhsoac.ca.gov/Meetings/docs/Meetings/2012/Nov/OAC_111512_Tab4_MHSA_CostOffset_Report_FSP.pdf Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 79 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Tables V.5 and V.6 display the same type of new enrollee, cost and cost offset information as in Tables V.3 and V.4, 232 but for Fiscal Year 09-10. Table V.5 Full Service Partnership Services: Number of New Enrollees by Age Group (Fiscal Year 09-10) Number of New Sum of Days Enrollees FY 08-09 Age Group Total Low High Total Low High CYF 3,101 9 2,223 454,605 1,369 580,545 TAY 2,977 25 1,257 496,190 6,517 333,383 Adults 4,702 37 4,176 868,415 9,000 1,148,521 Older Adults 645 1 373 103,459 7 98,535 Table V.6 Full Service Partnership Services: Expenditures and Cost Offsets by Age Group (Fiscal Year 09-10) Total Expenditures for FY 09-10 New Total Cost Offset FY 09-10 Enrollees Age Group Total Low High Total Low High CYF $21,775,579.50 $3,759.79 $72,054.99 $2,262,842.11 $86,851.14 $27,863,702.00 TAY $18,681,553.50 $6,753.44 $92,470.00 $27,501,007.94 $352,529.77 $21,698,945.60 Adults $56,212,502.95 $6,815.18 $64,318.98 $56,120,875.82 $254,338.00 $81,947,433.40 Older Adults $5,325,034.73 $14,593.75 $112,063.43 $3,857,684.17 $64,976.01 $5,720,395.00 The findings displayed in Tables V.3 through V .6 support a number of conclusions: Cost savings over the two-year period are consistent in relative magnitude across age groups. In particular, TAY consumers experienced the greatest cost-related benefits of service. Transition-Age Youth are at high risk for criminal justice and crisis management services, and FSP participation apparently has a significant impact on consequences for this age group. Cost offsets are dramatically lower for the CYF age group. This may reflect the more preventive orientation of services for children, which is not as clearly reflected in the short time line of the measured offsets. Savings for children may appear over a much longer period of time, outside the currently funded study period. In addition, the “consequence” nature of the offset categories examined (e.g., criminal justice involvement) is more relevant to older age cohorts. Effects of service are sensitive to life maturation, indicators of service success and the time horizon of measured effects. Overall, across all age groups, 75 and 88 percent of FSP expenditures for new enrollees in FY 08-09 and FY 09-10 (respectively) are offset by savings to the public mental health, health and justice systems. Although the argument of cost savings should never be advanced as the primary reason for providing public mental health services, results of this magnitude make a strong case for the wisdom of investing public resources in programs such as the Full Service Partnership. In summary, this analysis of cost offsets in larger social costs attributable to participation in the FSP program documents positive results. Results for the TAY and Adult age groups, which account for the great majority of clients, are particularly positive. These results are quite favorable when compared with AB 2034, a program charged with serving homeless (or at risk of becoming homeless) TAY and Adults with severe mental illness – the final analysis reported a percentage of costs offset of 49.8 percent. 232 See Appendix G for a display of the data shown in this table, by county. Again, note that small counties have been pooled for the purpose of display in Appendix G. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 80 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets c. Contextual Factors – Relationship to Cost Offsets In addition, an analysis of county contextual variables that may be related to cost offsets was conducted. This analysis (and the multivariate analyses preceding the results shown below) parallels the analysis of average daily FSP expenditures (Table IV.6). Variable definitions and analysis technique are the same as those described in that section. The dependent variable is total cost offset as a percentage of total expenditures. Table V.7 displays associations, as measured by Pearson’s correlation coefficients, between the individual, service, and county environment characteristics identified above, and average cost offset for each county. The pattern of association for cost offsets is quite different than that identified for expenditures. Table V.7 demonstrates the following patterns in association across the age groups. Table V.7. Correlations (Pearson’s) of FSP Services and County Characteristics to Average Cost Offsets for Counties (Fiscal Year 09-10) CYF TAY Adult Older Adult *Correlation is significant at the .05 Average Cost Average Cost Average Cost Average Cost level (2-tailed) Offset Offset Offset Offset Number of Counties 34 39 42 31 Number of Service Options -0.382* 0.048 -0.011 0.293 Evidence-Based Services -0.248 0.025 -0.113 0.233 Peer Services -0.314 -0.077 -0.070 0.100 Penetration Rate -0.057 -0.351* 0.263 0.292 Population Density 0.103 -0.251 -0.238 -0.236 Percent County Population Insured 0.196 0.095 -0.212 -0.301 Poverty Level -0.150 -0.208 0.176 0.168 Unemployment Rate -0.133 0.115 -0.100 -0.030 Rate of Foreclosures 0.083 0.088 0.005 0.019 The results displayed in Table V.7 highlight the: 1. relatively small degree to which these factors are associated with the FSP average cost offset across counties, 2. presence of only one factor that shows a consistent direction of association with the FSP average cost offset across all age groups (rate of foreclosures – positive correlation with each age group), and CYF TAY Adult Older Adult Average Cost Average Cost Average Cost Average Cost Offset Offset Offset Offset Rate of Foreclosures 0.083 0.088 0.005 0.019 3. degree to which other factors related to the FSP cost offsets differ across participant age groups (e.g., poverty level is negatively correlated with CYF and TAY average cost offset and positively correlated with Adult and Older Adult average cost offset). Please note that correlation does not equal causation – association merely means that two variables are related to one another, not that one variable changed the other variable in any way: Number of Service Options is associated with offsets for CYF. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 81 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets o The greater number of services offered, the lower average cost offset among CYF (significant at .05 level). In plain language, offering more services for CYF is not associated with greater cost offsets in the near term. However, it is not possible to know the impact after one year – CYF cost offsets may not be likely to appear until many years later, perhaps even into adolescence or young adulthood. Penetration Rate (ratio estimate of the prevalence of serious mental illness/serious emotional disturbance) is associated with offsets in all but the CYF group, but varies across age groups. o For TAY participants, a higher penetration rate is related (at .05 significance level) to lower average cost offset in counties. In order to examine select characteristics of FSP participants (gender, race/ethnicity), additional correlational analyses were conducted. The results are displayed in Table V.8. Table V.8. Correlations (Spearman’s Rank Order) of FSP Characteristics to FSP Average Cost Offset (Fiscal Year 09-10) CYF TAY Adult Older Adult Total Cost Total Cost Total Cost Total Cost Offset Offset Offset Offset Number of Counties 34 39 42 31 Gender 0.298 0.217 0.166 -0.097 Race -0.025 -0.054 0.142 -0.037 *Correlation is significant at the .05 level (2-tailed) The results displayed in Table V.8 highlight the relatively small degree to which FSP characteristics are associated with the FSP average cost offset across counties. The descriptive analyses examining participant characteristics suggests that cost offsets are less related to these factors than is daily service expenditure. d. Summary Cost savings over the two-year period are consistent in relative magnitude across age groups. In particular, TAY consumers experienced the greatest cost-related benefits of service. Transition-Age Youth are at high risk for criminal justice and crisis management services, and FSP participation apparently has a significant impact on consequences for this age group. Penetration Rate (ratio estimate of the prevalence of serious mental illness/serious emotional disturbance) is associated with lower average cost offset for TAY across counties. Cost offsets are dramatically lower for the CYF age group. This may reflect the more preventive orientation of services for children, which is not as clearly reflected in the short time line of the measured offsets. Savings for children may appear over a much longer period of time, outside the currently funded study period. In addition, the “consequence” nature of the offset categories examined (e.g., criminal justice involvement) is more relevant to older age cohorts. Effects of service are sensitive to life maturation, indicators of service success and the time horizon of measured effects. Number of Service Options is associated with offsets for CYF, in that the greater number of services offered, the lower average cost offset among CYF. In plain language, offering more services for CYF is not associated with greater cost offsets in the near term. However, it is not possible to know the impact after Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 82 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets one year – CYF cost offsets may not be likely to appear until many years later, perhaps even into adolescence or young adulthood. Overall, across all age groups, 75 and 88 percent of FSP costs for new enrollees in FY 08-09 and FY 09-10 (respectively) are offset by savings to the public mental health, health and justice systems. The moderate nature of the correlations between contextual factors and cost offsets suggests that other factors are responsible for variation between counties. Additional areas meriting investigation as potential reasons for variation between county were proposed in Chapter IV, and are equally valid to pursue when analyzing cost offsets, but require the investment of additional (new) data collection. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 83 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Appendix A Evaluation Advisory Group Members Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 84 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Evaluation Advisory Group Members 1. Maria Iyog-O’Malley, Former FSP Services Manager, San Francisco Department of Mental Health/UCLA Expert Consultant 2. Debbie Innes-Gomberg, Los Angeles County Department of Mental Health 3. Christina Cordova, Orange County Health Authority 4. Keith Erselius, San Bernardino Behavioral Health 5. Ruben Gasco, San Bernardino Behavioral Health 6. Keith Haigh, San Bernardino Behavioral Health 7. Brian Yates, American University, UCLA Expert Consultant 8. Todd Gilmer, University of San Diego, UCLA Expert Consultant 9. Steve Hahn-Smith, Contra Costa Health Services Department 10. Diane Prentiss, San Francisco Department of Public Health Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 85 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Appendix B FSP Services by County Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 86 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.1 Counties Reporting Planned Implementation of Full Service Partnership Services to CYF (N=54) Outreach & Engagement County o t h c a e rtu O & d e v re s re d n U d e v re s n U o t y tiro irP d e v re s n U s n o ita lu p o P y tilib ig ilE P S F ra e lC a ire tirC t n e m s s e s s A s d e e N la s u e d c i i v v i r d e n S I n a lP s tro p p u S & y re v ile D e c iv re S s d e e N n o d e s a b P S S I & tn e m s s e s s A Alameda   Alpine      Amador      Berkeley City      Butte    Calaveras      Colusa     Contra Costa       Del Norte   El Dorado     Fresno       Glenn       Humboldt* Imperial      Inyo* Kern       Kings     Lake       Lassen    Los Angeles      Madera   Marin      Mariposa   Mendocino     Merced      Modoc     Mono* Monterey      Napa       Nevada       Orange    Placer      Plumas       Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 87 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Outreach & Engagement y t s P County o t h c a e rtu O & d e v re s re d n U d e v re s n U o t y tiro irP d e v re s n U s n o ita lu p o P tilib ig ilE P S F ra e lC a ire tirC n e m s s e s s A s d e e N la u e d c i i v v i r d e n S I n a lP s tro p p u S & y re v ile D e c iv re S s d e e N n o d e s a b S S I & tn e m s s e s s A Riverside       Sacramento     San Benito       San Bernardino       San Diego       San Francisco       San Joaquin       San Luis Obispo      San Mateo       Santa Barbara   Santa Clara     Santa Cruz* Shasta       Sierra    Siskiyou    Solano     Sonoma     Stanislaus     Sutter-Yuba       Tehama* Tri-City     Trinity Tulare      Tuolumne       Ventura       Yolo    TOTAL 44 47 47 38 40 30 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 88 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.2 Counties Reporting Planned Implementation of Full Service Partnership Services to CYF (N=54) Personal Services General Standards Coordinator County d a o le s a C w o L e g a re v o C 7 / 4 2 n i s e c iv re S y tin u m m o C c in ilC e h t .v ,s s e n lle W ,y re v o c e R e c n e ilis e R d e re tn tn e e ilC C - e ra C y lim a F - e ra C d e re tn e C la ru tlu C e c n e te p m o C y tin u m m o C n o ita ro b a llo C d e ta rg e tn I e c iv re S e c n e ire p x E Alameda  Alpine          Amador      Berkeley City        Butte      Calaveras          Colusa         Contra Costa          Del Norte         El Dorado         Fresno          Glenn          Humboldt* Imperial          Inyo* Kern          Kings      Lake          Lassen        Los Angeles          Madera         Marin          Mariposa       Mendocino    Merced        Modoc         Mono* Monterey          Napa          Nevada          Orange          Placer        Plumas      Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 89 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Personal Services General Standards Coordinator County d a o le s a C w o L e g a re v o C 7 / 4 2 n i s e c iv re S y tin u m m o C c in ilC e h t .v ,s s e n lle W ,y re v o c e R e c n e ilis e R d e re tn tn e e ilC C - e ra C y lim a F - e ra C d e re tn e C la ru tlu C e c n e te p m o C y tin u m m o C n o ita ro b a llo C d e ta rg e tn I e c iv re S e c n e ire p x E Riverside          Sacramento         San Benito          San Bernardino          San Diego          San Francisco          San Joaquin        San Luis Obispo          San Mateo          Santa Barbara     Santa Clara       Santa Cruz* Shasta         Sierra        Siskiyou       Solano     Sonoma         Stanislaus          Sutter-Yuba          Tehama* Tri-City         Trinity  Tulare        Tuolumne          Ventura         Yolo         TOTAL 35 46 42 54 37 45 52 49 44 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 90 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.3 Counties Reporting Planned Implementation of Full Service Partnership Services to CYF (N=54) Outpatient Mental Health Services County la u d iv id n I y p a re h T p u o rG y p a re h T n o ita c id e M tro p p u S s is irC n o itn e v re tn I e s a C tn e m e g a n a M Alameda  Alpine    Amador    Berkeley City   Butte    Calaveras  Colusa   Contra Costa      Del Norte El Dorado Fresno     Glenn      Humboldt* Imperial     Inyo* Kern      Kings    Lake    Lassen Los Angeles      Madera  Marin   Mariposa    Mendocino  Merced    Modoc  Mono* Monterey     Napa     Nevada     Orange      Placer  Plumas   Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 91 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Outpatient Mental Health Services County la u d iv id n I y p a re h T p u o rG y p a re h T n o ita c id e M tro p p u S s is irC n o itn e v re tn I e s a C tn e m e g a n a M Riverside      Sacramento    San Benito      San Bernardino      San Diego     San Francisco      San Joaquin      San Luis Obispo     San Mateo      Santa Barbara  Santa Clara   Santa Cruz* Shasta    Sierra  Siskiyou   Solano  Sonoma     Stanislaus      Sutter-Yuba      Tehama* Tri-City  Trinity Tulare    Tuolumne      Ventura     Yolo    TOTAL 39 27 26 41 35 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 92 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.4 Counties Reporting Planned Implementation of Full Service Partnership Services to CYF (N=54) Other Supports County la tn e m u rts n I s d e e N fo ts o C e ra c h tla e H tn e m ta e rT s e c iv re S e tip s e R d e tro p p u S / tn e m y o lp m E n o ita c u d E o h c y s P - n o ita c u d e y lim a F n o ita c u d E / la n o ita c u d E tn e m y o lp m E s e ilp p u S la n o ita e rc e R s e itiv itc A n o ita tro p s n a rT g n itn e ra P n o ita c u d E e ta m itn I re n tra P e c n e lo iV s e c iv re S Alameda Alpine       Amador Berkeley City     Butte      Calaveras    Colusa   Contra Costa        Del Norte  El Dorado       Fresno       Glenn       Humboldt* Imperial         Inyo* Kern          Kings   Lake          Lassen  Los Angeles         Madera      Marin Mariposa    Mendocino  Merced     Modoc  Mono*  Monterey    Napa          Nevada    Orange       Placer  Plumas      Riverside          Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 93 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Other Supports County la tn e m u rts n I s d e e N fo ts o C e ra c h tla e H tn e m ta e rT s e c iv re S e tip s e R d e tro p p u S / tn e m y o lp m E n o ita c u d E o h c y s P - n o ita c u d e y lim a F n o ita c u d E / la n o ita c u d E tn e m y o lp m E s e ilp p u S la n o ita e rc e R s e itiv itc A n o ita tro p s n a rT g n itn e ra P n o ita c u d E e ta m itn I re n tra P e c n e lo iV s e c iv re S Sacramento      San Benito       San Bernardino         San Diego   San Francisco        San Joaquin      San Luis Obispo     San Mateo           Santa Barbara Santa Clara  Santa Cruz* Shasta           Sierra  Siskiyou    Solano     Sonoma   Stanislaus      Sutter-Yuba           Tehama* Tri-City  Trinity Tulare       Tuolumne          Ventura     Yolo      TOTAL 29 11 17 3 29 33 31 23 34 26 6 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 94 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.5 Counties Reporting Planned Implementation of Full Service Partnership Services – Peer Support – Specific Positions for Parent Peers (N=54) Peer Support Services / County re e P / s ro tn e M t n e m ts u jd A s e h c a o C s e h c a o C b o J la n o ita c u d E s ro t u T / s e h c a o C s re g a n a M e s a C s ro ta c u d E tn e ra P p u o rG tro p p u S s ro ta c u d E re e P s e ta c o v d A Alameda   Alpine   Amador  Berkeley City  Butte    Calaveras  Colusa   Contra Costa    Del Norte  El Dorado    Fresno    Glenn    Humboldt* Imperial   Inyo* Kern   Kings   Lake     Lassen  Los Angeles   Madera   Marin     Mariposa  Mendocino   Merced   Modoc   Mono* Monterey      Napa    Nevada      Orange   Placer   Plumas Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 95 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Peer Support Services / County re e P / s ro tn e M t n e m ts u jd A s e h c a o C s e h c a o C b o J la n o ita c u d E / s e s h r c o a t o u C T s re g a n a M e s a C s ro ta c u d E tn e ra P p u o rG tro p p u S s ro ta c u d E re e P s e ta c o v d A Riverside      Sacramento       San Benito       San Bernardino  San Diego    San Francisco     San Joaquin    San Luis Obispo    San Mateo      Santa Barbara Santa Clara Santa Cruz* Shasta   Sierra    Siskiyou   Solano    Sonoma   Stanislaus     Sutter-Yuba  Tehama* Tri-City    Trinity   Tulare    Tuolumne   Ventura      Yolo  TOTAL 36 9 11 7 21 29 24 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 96 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.6 Counties Reporting Planned Implementation of Full Service Partnership Services – Peer Support – Strategies where Peers are part of Team for Child (N=54) Peer Support Services y ,g County e s u o h b u lC / s re tn p e o C r n D -i s e n iL m ra W tn e m e g a g n E d n a h c a e rtu O s e itiv it c A n o ita e rc e R / la ic o S tro p p u S e ra C d lih C n o ita tro p s n a rT tro p p u S g n is u o H fle s a , d .g y . r e e ( v s e e , s p s l a e l h C - )tn e m e g a n a m ,.g .e ( tro p p u S la tn e m u rts n I n ip p o h s y re c o rg ,g n ip e e k e s u o h )s d e e n la re n e g y tilic a F / g n ip e e K s d n u o rG e c n a n e tn ia M tro p p u S e m o n H - I e ra C e tip s e R n o itn e v re tn I s is irC n o ita tilib a h e R n o itn e v re t n I a m u a rT / e c n e lo iV Alameda Alpine    Amador   Berkeley City Butte         Calaveras  Colusa   Contra Costa    Del Norte    El Dorado    Fresno  Glenn       Humboldt* Imperial   Inyo* Kern  Kings    Lake       Lassen  Los Angeles Madera    Marin    Mariposa Mendocino      Merced   Modoc    Mono* Monterey    Napa           Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 97 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Peer Support Services y ,g County e s u o h b u lC / s re tn p e o C r n D -i s e n iL m ra W tn e m e g a g n E d n a h c a e rtu O s e itiv it c A n o ita e rc e R / la ic o S tro p p u S e ra C d lih C n o ita tro p s n a rT tro p p u S g n is u o H fle s a , d .g y . r e e ( v s e e , s p s l a e l h C - )tn e m e g a n a m ,.g .e ( tro p p u S la tn e m u rts n I n ip p o h s y re c o rg ,g n ip e e k e s u o h )s d e e n la re n e g y tilic a F / g n ip e e K s d n u o rG e c n a n e tn ia M tro p p u S e m o n H - I e ra C e tip s e R n o itn e v re tn I s is irC n o ita tilib a h e R n o itn e v re t n I a m u a rT / e c n e lo iV Nevada  Orange Placer  Plumas  Riverside      Sacramento     San Benito   San Bernardino  San Diego   San Francisco     San Joaquin    San Luis Obispo    San Mateo       Santa Barbara Santa Clara Santa Cruz* Shasta      Sierra     Siskiyou  Solano Sonoma  Stanislaus       Sutter-Yuba   Tehama* Tri-City Trinity  Tulare   Tuolumne      Ventura     Yolo  TOTAL 16 12 30 22 3 16 10 14 3 0 3 2 7 0 1 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 98 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.7 Counties Reporting Planned Implementation of Full Service Partnership Services – Peer Support – Peers Augmenting the Overall Capacity of the Staff Team for Child (N=54) Peer Support Services County s p u o rG tro p p u S y lla ru tlu C lliF / tn e te p m o C s e itira p s iD c in h tE Q T G B L d n a la c in ilC tro p p u S re e P / y lim a F ffa tS e c n e ire p x E re m u s n o C )y ro ts rie h t e ra h s ( h tiw n o ita ro b a llo C / s e i c r n e e h g tO A y tin u m m o C d n a tn e m tiu rc e R g n iriH s llik S n o ita z ila ic o S s llik S n o ita c in u m m o C Alameda   Alpine       Amador   Berkeley City   Butte       Calaveras Colusa  Contra Costa   Del Norte  El Dorado     Fresno Glenn    Humboldt* Imperial    Inyo* Kern    Kings  Lake    Lassen     Los Angeles    Madera     Marin   Mariposa  Mendocino     Merced   Modoc   Mono* Monterey     Napa      Nevada      Orange  Placer Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 99 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Peer Support Services County s p u o rG tro p p u S y lla ru tlu C lliF / tn e te p m o C s e itira p s iD c in h tE Q T G B L d n a la c in ilC tro p p u S re e P / y lim a F ffa tS e c n e ire p x E re m u s n o C )y ro ts rie h t e ra h s ( h tiw n o ita ro b a llo C / s e i c r n e e h g tO A y tin u m m o C d n a tn e m tiu rc e R g n iriH s llik S n o ita z ila ic o S s llik S n o ita c in u m m o C Plumas  Riverside       Sacramento        San Benito     San Bernardino San Diego     San Francisco      San Joaquin     San Luis Obispo  San Mateo        Santa Barbara Santa Clara Santa Cruz* Shasta      Sierra    Siskiyou  Solano  Sonoma   Stanislaus     Sutter-Yuba  Tehama* Tri-City   Trinity    Tulare    Tuolumne    Ventura   Yolo   TOTAL 32 30 6 28 4 21 20 7 2 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 100 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.8 Counties Reporting Planned Implementation of Full Service Partnership Services to Children, Youth and Families: Housing (N=54) g g n n is is u u County o County o H H Alameda Orange  Alpine  Placer  Amador Plumas  Berkeley City Riverside  Butte  Sacramento  Calaveras  San Benito  Colusa  San Bernardino  Contra Costa  San Diego Del Norte San Francisco  El Dorado San Joaquin  Fresno  San Luis Obispo Glenn  San Mateo  Humboldt* Santa Barbara Imperial  Santa Clara  Inyo* Santa Cruz* Kern  Shasta  Kings  Sierra  Lake  Siskiyou  Lassen Solano  Los Angeles  Sonoma Madera  Stanislaus Marin Sutter-Yuba  Mariposa Tehama* Mendocino Tri-City  Merced  Trinity Modoc  Tulare  Mono* Tuolumne  Monterey Ventura Napa  Yolo  Nevada  TOTAL 37 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 101 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.9 Counties Reporting Planned Implementation of Full Service Partnership Services to CYF (N=54) MH Staff SA Tx County fo re b m u N / ts irta ih c y s P ffa tS P N la ic o S fo re b m u N ffa tS re k ro W h c a o rp p A m a e T e s u b A e c n a ts b u S tn e m ta e rT Alameda Alpine  Amador  Berkeley City Butte  Calaveras  Colusa Contra Costa     Del Norte El Dorado  Fresno     Glenn     Humboldt* Imperial     Inyo* Kern    Kings  Lake  Lassen  Los Angeles    Madera Marin  Mariposa  Mendocino Merced   Modoc    Mono* Monterey    Napa    Nevada     Orange    Placer Plumas  Riverside  Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 102 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets MH Staff SA Tx County fo re b m u N / ts irta ih c y s P ffa tS P N la ic o S fo re b m u N ffa tS re k ro W h c a o rp p A m a e T e s u b A e c n a ts b u S tn e m ta e rT Sacramento  San Benito     San Bernardino     San Diego San Francisco     San Joaquin   San Luis Obispo    San Mateo     Santa Barbara  Santa Clara  Santa Cruz* Shasta     Sierra  Siskiyou   Solano Sonoma  Stanislaus    Sutter-Yuba   Tehama* Tri-City  Trinity Tulare   Tuolumne     Ventura  Yolo   TOTAL 25 22 24 28 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 103 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.10 Counties Reporting Planned Implementation of Full Service Partnership Services to CYF (N=54) Disch- Evidence-Based Practices Other Practices Coordination arge County la ro iv a h e B e v itin g o C y p a re h T g n in ia rT s llik S la ic o S y p a re h T ro iv a h e B g n ile d o M y lim a F n o ita c u d e o h c y s P c im e ts y s itlu M y p a re h T re ts o F c itu e p a re h T e ra C tn d e l r ih a P C - n o itc a re tn I d n u o ra p a rW e v ita n re tlA tn e m ta e rT y l l c a i r fi u c t e lu p C S -tn e m ta e rT la tip s o H n o ita n id ro o C e c its u J la n im irC n o ita n id ro o C a ire tirC / g n in n a lP Alameda  Alpine    Amador    Berkeley City     Butte Calaveras     Colusa    Contra Costa   Del Norte    El Dorado   Fresno     Glenn            Humboldt* Imperial     Inyo* Kern          Kings     Lake       Lassen  Los Angeles       Madera    Marin  Mariposa   Mendocino  Merced      Modoc Mono* Monterey     Napa      Nevada        Orange        Placer    Plumas  Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 104 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Disch- Evidence-Based Practices Other Practices Coordination arge County la ro iv a h e B e v itin g o C y p a re h T g n in ia rT s llik S la ic o S y p a re h T ro iv a h e B g n ile d o M y lim a F n o ita c u d e o h c y s P c im e ts y s itlu M y p a re h T re ts o F c itu e p a re h T e ra C tn d e l r ih a P C - n o itc a re tn I d n u o ra p a rW e v ita n re tlA tn e m ta e rT y l l c a i r fi u c t e lu p C S -tn e m ta e rT la tip s o H n o ita n id ro o C e c its u J la n im irC n o ita n id ro o C a ire tirC / g n in n a lP Riverside         Sacramento     San Benito           San Bernardino           San Diego   San Francisco     San Joaquin      San Luis Obispo    San Mateo            Santa Barbara Santa Clara    Santa Cruz* Shasta       Sierra  Siskiyou Solano Sonoma      Stanislaus      Sutter-Yuba         Tehama* Tri-City   Trinity   Tulare    Tuolumne           Ventura  Yolo TOTAL 14 13 12 4 14 2 6 12 39 7 23 17 33 16 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 105 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.11 Counties Reporting Planned Implementation of Full Service Partnership Services to Transition-Age Youth (N=59) Outreach and Engagement County o t h c a e rtu O & d e v re s re d n U d e v re s n U o t y tiro irP d e v re s n U s n o ita lu p o P P S F ra e lC y tilib ig ilE a ire tirC s d e e N tn e m s s e s s A la u d iv id n I & s e c iv re S n a lP s tro p p u S y re v ile D e c iv re S s d e e N n o d e s a b & tn e m s s e s s A P S S I Alameda       Alpine      Amador     Berkeley City      Butte    Calaveras      Colusa     Contra Costa       Del Norte     El Dorado      Fresno      Glenn       Humboldt       Imperial       Inyo     Kern       Kings     Lake       Lassen    Los Angeles       Madera   Marin       Mariposa   Mendocino    Merced       Modoc     Mono     Monterey       Napa       Nevada       Orange      Placer       Plumas       Riverside       Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 106 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Outreach and Engagement County o t h c a e rtu O & d e v re s re d n U d e v re s n U o t y tiro irP d e v re s n U s n o ita lu p o P P S F ra e lC y tilib ig ilE a ire tirC s d e e N tn e m s s e s s A la u d iv id n I & s e c iv re S n a lP s tro p p u S y re v ile D e c iv re S s d e e N n o d e s a b & tn e m s s e s s A P S S I Sacramento      San Benito       San Bernardino       San Diego       San Francisco       San Joaquin       San Luis Obispo      San Mateo       Santa Barbara       Santa Clara      Santa Cruz    Shasta       Sierra      Siskiyou    Solano     Sonoma    Stanislaus       Sutter-Yuba       Tehama      Tri-City     Trinity       Tulare      Tuolumne       Ventura      Yolo     TOTAL 55 52 54 46 50 38 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 107 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.12 Counties Reporting Planned Implementation of Full Service Partnership Services to Transition-Age Youth (N=59) Personal Services General Standards Coordinator e County d a o le s a C w o L e g a re v o C 7 / 4 2 n i s e c iv re S y tin u m m o C c in ilC e h t .v ,s s e n lle W ,y re v o c e R e c n e ilis e R d e re tn tn e e ilC C - e ra C d e r y e li t m n e a C F - e ra C la ru tlu C e c n e te p m o C y tin u m m o C n o ita ro b a llo C c iv re S d e ta rg e tn I e c n e ire p x E Alameda          Alpine          Amador   Berkeley City         Butte      Calaveras        Colusa         Contra Costa          Del Norte         El Dorado       Fresno         Glenn          Humboldt         Imperial          Inyo        Kern          Kings       Lake          Lassen        Los Angeles         Madera          Marin          Mariposa       Mendocino       Merced          Modoc        Mono         Monterey         Napa          Nevada          Orange          Placer          Plumas      Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 108 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Personal Services General Standards Coordinator e County d a o le s a C w o L e g a re v o C 7 / 4 2 n i s e c iv re S y tin u m m o C c in ilC e h t .v ,s s e n lle W ,y re v o c e R e c n e ilis e R d e re tn tn e e ilC C - e ra C d e r y e li t m n e a C F - e ra C la ru tlu C e c n e te p m o C y tin u m m o C n o ita ro b a llo C c iv re S d e ta rg e tn I e c n e ire p x E Riverside          Sacramento        San Benito          San Bernardino          San Diego         San Francisco          San Joaquin        San Luis Obispo        San Mateo          Santa Barbara          Santa Clara       Santa Cruz       Shasta         Sierra         Siskiyou       Solano        Sonoma         Stanislaus          Sutter-Yuba          Tehama          Tri-City         Trinity        Tulare        Tuolumne          Ventura       Yolo       TOTAL 39 54 44 59 46 44 58 57 53 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 109 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.13 Counties Reporting Planned Implementation of Full Service Partnership Services to Transition-Age Youth (N=59) Outpatient Mental Health Services County la u d iv id n I y p a re h T p u o rG y p a re h T n o ita c id e M tro p p u S s is irC n o itn e v re tn I e s a C tn e m e g a n a M Alameda   Alpine     Amador   Berkeley City    Butte    Calaveras  Colusa   Contra Costa      Del Norte     El Dorado  Fresno      Glenn      Humboldt    Imperial     Inyo     Kern      Kings    Lake    Lassen Los Angeles      Madera    Marin     Mariposa    Mendocino   Merced      Modoc  Mono   Monterey  Napa      Nevada      Orange      Placer      Plumas   Riverside  Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 110 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Outpatient Mental Health Services County la u d iv id n I y p a re h T p u o rG y p a re h T n o ita c id e M tro p p u S s is irC n o itn e v re tn I e s a C tn e m e g a n a M Sacramento     San Benito      San Bernardino      San Diego     San Francisco      San Joaquin      San Luis Obispo     San Mateo      Santa Barbara      Santa Clara   Santa Cruz   Shasta    Sierra   Siskiyou   Solano  Sonoma     Stanislaus      Sutter-Yuba      Tehama    Tri-City  Trinity  Tulare    Tuolumne      Ventura     Yolo TOTAL 31 30 35 44 53 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 111 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.14 Counties Reporting Planned Implementation of Full Service Partnership Services to Transition-Age Youth (N=59) Other Supports s e n County la tn e m u rts n I s d e e N fo ts o C e ra c h tla e H tn e m ta e rT c iv re S e tip s e R d e tro p p u S tn e m y o lp m E o h c y s P - n o ita c u d e y lim a F n o ita c u d E / la n o ita c u d E tn e m y o lp m E s e ilp p u S la n o ita e rc e R s e itiv itc A o ita tro p s n a rT g n itn e ra P n o ita c u d E e ta m itn I re n tra P e c n e lo iV s e c iv re S Alameda   Alpine    Amador Berkeley City     Butte      Calaveras     Colusa   Contra Costa        Del Norte    El Dorado      Fresno      Glenn        Humboldt  Imperial         Inyo    Kern         Kings   Lake          Lassen  Los Angeles       Madera      Marin    Mariposa    Mendocino Merced       Modoc  Mono        Monterey     Napa           Nevada      Orange        Placer     Plumas      Riverside      Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 112 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Other Supports s e n County la tn e m u rts n I s d e e N fo ts o C e ra c h tla e H tn e m ta e rT c iv re S e tip s e R d e tro p p u S tn e m y o lp m E o h c y s P - n o ita c u d e y lim a F n o ita c u d E / la n o ita c u d E tn e m y o lp m E s e ilp p u S la n o ita e rc e R s e itiv itc A o ita tro p s n a rT g n itn e ra P n o ita c u d E e ta m itn I re n tra P e c n e lo iV s e c iv re S Sacramento       San Benito      San Bernardino        San Diego    San Francisco      San Joaquin     San Luis Obispo   San Mateo            Santa Barbara            Santa Clara  Santa Cruz Shasta            Sierra       Siskiyou    Solano  Sonoma   Stanislaus      Sutter-Yuba           Tehama  Tri-City  Trinity    Tulare       Tuolumne           Ventura     Yolo    TOTAL 32 10 15 11 33 35 33 32 40 21 9 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 113 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.15 Counties Reporting Planned Implementation of Full Service Partnership Services – Peer Support – Specific Positions for Peers for TAY (N=59) Peer Support Services / County re e P / s ro tn e M t n e m ts u jd A s e h c a o C s e h c a b o o C J la n o ita c u d E s ro t u T / s e h c a o C s re g a n a M e s a C s ro ta c u d E tn e ra P p u o rG tro p p u S s ro ta c u d E re e P s e ta c o v d A Alameda   Alpine     Amador     Berkeley City     Butte    Calaveras  Colusa   Contra Costa    Del Norte  El Dorado     Fresno      Glenn        Humboldt  Imperial       Inyo    Kern      Kings    Lake     Lassen  Los Angeles    Madera Marin      Mariposa  Mendocino     Merced    Modoc   Mono  Monterey       Napa      Nevada      Orange    Placer   Plumas Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 114 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Peer Support Services / County re e P / s ro tn e M t n e m ts u jd A s e h c a o C s e h c a b o o C J la n o ita c u d E s ro t u T / s e h c a o C s re g a n a M e s a C s ro ta c u d E tn e ra P p u o rG tro p p u S s ro ta c u d E re e P s e ta c o v d A Riverside       Sacramento       San Benito       San Bernardino    San Diego      San Francisco      San Joaquin  San Luis Obispo    San Mateo      Santa Barbara      Santa Clara  Santa Cruz   Shasta    Sierra    Siskiyou   Solano      Sonoma    Stanislaus     Sutter-Yuba  Tehama      Tri-City    Trinity     Tulare    Tuolumne   Ventura     Yolo   TOTAL 41 21 21 13 25 42 32 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 115 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.16 Counties Reporting Planned Implementation of Full Service Partnership Services – Peer Support – Strategies where Peers are part of Team for TAY (N=59) Peer Support Services y ,g County e s u o h b u lC / s re tn p e o C r n D -i s e n iL m ra W tn e m e g h a c g a n e E r d tu n O a s e itiv it c A n o ita e rc e R / la ic o S tro p p u S e ra C d lih C n o ita tro p s n a rT tro p p u S g n is u o H fle s a , d .g y . r e e ( v s e e , s p s l a e l h C - )tn e m e g a n a m ,.g .e ( tro p p u S la tn e m u rts n I n ip p o h s y re c o rg ,g n ip e e k e s u o h )s d e e n la re n e g y tilic a F / g n ip e e K s d n u o rG e c n a n e tn ia M tro p p u S e m o n H - I e ra C e tip s e R n o itn e v re tn I s is irC n o ita tilib a h e R n o itn e v re t n I a m u a rT / e c n e lo iV Alameda Alpine    Amador      Berkeley City  Butte        Calaveras   Colusa   Contra Costa     Del Norte    El Dorado      Fresno Glenn         Humboldt  Imperial           Inyo    Kern     Kings      Lake       Lassen  Los Angeles   Madera    Marin     Mariposa Mendocino      Merced   Modoc     Mono Monterey        Napa          Nevada  Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 116 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Peer Support Services y ,g County e s u o h b u lC / s re tn p e o C r n D -i s e n iL m ra W tn e m e g h a c g a n e E r d tu n O a s e itiv it c A n o ita e rc e R / la ic o S tro p p u S e ra C d lih C n o ita tro p s n a rT tro p p u S g n is u o H fle s a , d .g y . r e e ( v s e e , s p s l a e l h C - )tn e m e g a n a m ,.g .e ( tro p p u S la tn e m u rts n I n ip p o h s y re c o rg ,g n ip e e k e s u o h )s d e e n la re n e g y tilic a F / g n ip e e K s d n u o rG e c n a n e tn ia M tro p p u S e m o n H - I e ra C e tip s e R n o itn e v re tn I s is irC n o ita tilib a h e R n o itn e v re t n I a m u a rT / e c n e lo iV Orange  Placer  Plumas  Riverside       Sacramento     San Benito     San Bernardino    San Diego         San Francisco    San Joaquin     San Luis Obispo    San Mateo       Santa Barbara             Santa Clara     Santa Cruz Shasta      Sierra    Siskiyou  Solano  Sonoma  Stanislaus       Sutter-Yuba    Tehama    Tri-City Trinity  Tulare   Tuolumne      Ventura     Yolo  TOTAL 26 13 36 30 5 22 19 22 5 1 4 3 10 6 1 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 117 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.17 Counties Reporting Planned Implementation of Full Service Partnership Services – Peer Support – Peers Augmenting the Overall Capacity of the Staff Team for TAY (N=59) Peer Support Services County t s ro p p u p o u rG S y lla ru tlu C lliF / tn e te p m o C s e itira p s iD c in h tE Q T G B L d n a la c in ilC tro p p u S re e P / y lim a F ffa tS e c n e ire p x E re m u s n o C )y ro ts rie h t e ra h s ( h tiw n o ita ro b a llo C / s e ic n e g A re h tO y tin u m m o C d n a tn e m tiu rc e R g n iriH s llik S n o ita z ila ic o S s llik S n o ita c in u m m o C Alameda   Alpine       Amador        Berkeley City      Butte       Calaveras   Colusa   Contra Costa   Del Norte   El Dorado      Fresno  Glenn       Humboldt    Imperial       Inyo    Kern     Kings  Lake       Lassen     Los Angeles    Madera     Marin     Mariposa  Mendocino     Merced    Modoc   Mono   Monterey      Napa       Nevada       Orange  Placer  Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 118 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Peer Support Services County t s ro p p u p o u rG S y lla ru tlu C lliF / tn e te p m o C s e itira p s iD c in h tE Q T G B L d n a la c in ilC tro p p u S re e P / y lim a F ffa tS e c n e ire p x E re m u s n o C )y ro ts rie h t e ra h s ( h tiw n o ita ro b a llo C / s e ic n e g A re h tO y tin u m m o C d n a tn e m tiu rc e R g n iriH s llik S n o ita z ila ic o S s llik S n o ita c in u m m o C Plumas  Riverside       Sacramento       San Benito      San Bernardino  San Diego       San Francisco     San Joaquin    San Luis Obispo  San Mateo          Santa Barbara          Santa Clara    Santa Cruz    Shasta       Sierra   Siskiyou Solano   Sonoma    Stanislaus      Sutter-Yuba     Tehama  Tri-City   Trinity     Tulare    Tuolumne    Ventura   Yolo      TOTAL 45 40 11 36 9 31 28 11 3 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 119 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.18 Counties Reporting Planned Implementation of Full Service Partnership Services to Transition-Age Youth: Housing (N=59) g g n n is is u u County o County o H H Alameda  Orange  Alpine  Placer  Amador Plumas  Berkeley City Riverside  Butte  Sacramento  Calaveras  San Benito  Colusa  San Bernardino  Contra Costa  San Diego  Del Norte  San Francisco  El Dorado  San Joaquin  Fresno  San Luis Obispo  Glenn  San Mateo  Humboldt  Santa Barbara  Imperial  Santa Clara  Inyo  Santa Cruz  Kern  Shasta  Kings  Sierra  Lake  Siskiyou  Lassen  Solano Los Angeles  Sonoma  Madera  Stanislaus  Marin  Sutter-Yuba  Mariposa Tehama  Mendocino  Tri-City  Merced  Trinity  Modoc  Tulare  Mono  Tuolumne  Monterey  Ventura  Napa  Yolo  Nevada  TOTAL 55 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 120 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.19 Counties Reporting Planned Implementation of Full Service Partnership Services to TAY (N=59) MH Staff SA Tx County fo re b m u N / ts irta ih c y s P ffa tS P N la ic o S fo re b m u N re k f r f o a W tS h c a o rp p A m a e T e s u b A e c n a ts b u S tn e m ta e rT Alameda     Alpine  Amador  Berkeley City  Butte  Calaveras  Colusa Contra Costa     Del Norte  El Dorado  Fresno     Glenn     Humboldt  Imperial     Inyo  Kern     Kings  Lake   Lassen  Los Angeles    Madera  Marin     Mariposa  Mendocino Merced    Modoc    Mono   Monterey    Napa    Nevada     Orange   Placer   Plumas  Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 121 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets MH Staff SA Tx County fo re b m u N / ts irta ih c y s P ffa tS P N la ic o S fo re b m u N re k f r f o a W tS h c a o rp p A m a e T e s u b A e c n a ts b u S tn e m ta e rT Riverside    Sacramento  San Benito     San Bernardino     San Diego    San Francisco    San Joaquin    San Luis Obispo    San Mateo     Santa Barbara     Santa Clara  Santa Cruz Shasta     Sierra    Siskiyou   Solano  Sonoma   Stanislaus     Sutter-Yuba   Tehama     Tri-City  Trinity Tulare   Tuolumne     Ventura   Yolo   TOTAL 28 25 33 49 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 122 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.20 Counties Reporting Planned Implementation of Full Service Partnership Services to TAY (n=59) Other Dis- Evidence-Based Practices Coordination Practices charge County y re v o c e R s s e n lle W n a lP n o itc A e v itin g o C y p a re h T la ro iv a h e B la r c o it iv c a e h la e iD B y p a re h T s llik S la ic o S g n in ia rT y p a re h T ro iv a h e B g n ile d o M y lim a F n o ita c u d e o h c y s P c im e ts y s itlu M y p a re h T e v ita n re tlA tn e m ta e rT y l l c a i r fi u c t e lu p C S -tn e m ta e rT la tip s o H n o ita n id ro o C e c its u J la n im irC n o ita n id ro o C a ire tirC / g n in n a lP Alameda   Alpine     Amador  Berkeley City    Butte Calaveras      Colusa    Contra Costa    Del Norte     El Dorado   Fresno       Glenn            Humboldt    Imperial        Inyo      Kern           Kings      Lake      Lassen   Los Angeles         Madera    Marin    Mariposa   Mendocino  Merced   Modoc Mono  Monterey    Napa       Nevada         Orange     Placer Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 123 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Other Dis- Evidence-Based Practices Coordination Practices charge County y re v o c e R s s e n lle W n a lP n o itc A e v itin g o C y p a re h T la ro iv a h e B la r c o it iv c a e h la e iD B y p a re h T s llik S la ic o S g n in ia rT y p a re h T ro iv a h e B g n ile d o M y lim a F n o ita c u d e o h c y s P c im e ts y s itlu M y p a re h T e v ita n re tlA tn e m ta e rT y l l c a i r fi u c t e lu p C S -tn e m ta e rT la tip s o H n o ita n id ro o C e c its u J la n im irC n o ita n id ro o C a ire tirC / g n in n a lP Plumas Riverside    Sacramento        San Benito           San Bernardino        San Diego    San Francisco    San Joaquin     San Luis Obispo   San Mateo            Santa Barbara              Santa Clara  Santa Cruz Shasta       Sierra      Siskiyou Solano  Sonoma    Stanislaus       Sutter-Yuba        Tehama Tri-City   Trinity    Tulare     Tuolumne            Ventura    Yolo TOTAL 35 15 8 20 12 6 19 3 16 25 20 40 18 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 124 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.21 Counties Reporting Planned Implementation of Full Service Partnership Services to Adults (N=59) Outreach and Engagement County o t h c a e rtu O & d e v re s re d n U d e v re s n U o t y tiro irP d e v re s n U s n o ita lu p o P P S F ra e lC a ire tirC y tilib ig ilE s d e e N tn e m s s e s s A la u d iv id n I & s e c iv re S n a lP s tro p p u S y re v ile D e c iv re S s d e e N n o d e s a b & tn e m s s e s s A P S S I Alameda       Alpine     Amador     Berkeley City     Butte       Calaveras    Colusa    Contra Costa       Del Norte   El Dorado      Fresno      Glenn       Humboldt       Imperial       Inyo      Kern       Kings     Lake       Lassen   Los Angeles       Madera   Marin      Mariposa  Mendocino       Merced     Modoc     Mono     Monterey       Napa       Nevada     Orange     Placer       Plumas       Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 125 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Outreach and Engagement County o t h c a e rtu O & d e v re s re d n U d e v re s n U o t y tiro irP d e v re s n U s n o ita lu p o P P S F ra e lC a ire tirC y tilib ig ilE s d e e N tn e m s s e s s A la u d iv id n I & s e c iv re S n a lP s tro p p u S y re v ile D e c iv re S s d e e N n o d e s a b & tn e m s s e s s A P S S I Riverside       Sacramento      San Benito       San Bernardino       San Diego       San Francisco       San Joaquin       San Luis Obispo       San Mateo       Santa Barbara       Santa Clara      Santa Cruz   Shasta       Sierra       Siskiyou    Solano   Sonoma   Stanislaus       Sutter-Yuba       Tehama     Tri-City     Trinity       Tulare     Tuolumne       Ventura       Yolo    TOTAL 55 54 47 44 46 37 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 126 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.22 Counties Reporting Planned Implementation of Full Service Partnership Services to Adults (N=59) Personal Services General Standards Coordinator e County d a o le s a C w o L e g a re v o C 7 / 4 2 n i s e c iv re S y tin u m m o C c in ilC e h t .v ,s s e n lle W ,y re v o c e R e c n e ilis e R d e re tn tn e e ilC C - e ra C d e r y e li t m n e a C F - e ra C y lla ru tlu C e c n e te p m o C y tin u m m o C n o ita ro b a llo C c iv re S d e ta rg e tn I e c n e ire p x E Alameda          Alpine          Amador   Berkeley City         Butte         Calaveras       Colusa     Contra Costa          Del Norte         El Dorado       Fresno         Glenn          Humboldt         Imperial        Inyo       Kern          Kings     Lake          Lassen       Los Angeles          Madera        Marin       Mariposa    Mendocino        Merced          Modoc        Mono         Monterey          Napa        Nevada          Orange         Placer         Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 127 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Personal Services General Standards Coordinator e County d a o le s a C w o L e g a re v o C 7 / 4 2 n i s e c iv re S y tin u m m o C c in ilC e h t .v ,s s e n lle W ,y re v o c e R e c n e ilis e R d e re tn tn e e ilC C - e ra C d e r y e li t m n e a C F - e ra C y lla ru tlu C e c n e te p m o C y tin u m m o C n o ita ro b a llo C c iv re S d e ta rg e tn I e c n e ire p x E Plumas      Riverside          Sacramento       San Benito          San Bernardino         San Diego         San Francisco         San Joaquin        San Luis Obispo         San Mateo          Santa Barbara          Santa Clara        Santa Cruz    Shasta         Sierra         Siskiyou       Solano   Sonoma         Stanislaus          Sutter-Yuba          Tehama         Tri-City         Trinity         Tulare        Tuolumne          Ventura     Yolo        TOTAL 38 53 41 59 44 39 57 47 52 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 128 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.23 Counties Reporting Planned Implementation of Full Service Partnership Services to Adults (N=59) Outpatient Mental Health Services County la u d iv id n I y p a re h T p u o rG y p a re h T n o ita c id e M tro p p u S s is irC n o itn e v re tn I e s a C tn e m e g a n a M Alameda   Alpine    Amador   Berkeley City   Butte   Calaveras  Colusa  Contra Costa      Del Norte    El Dorado  Fresno     Glenn      Humboldt    Imperial   Inyo      Kern      Kings   Lake    Lassen Los Angeles      Madera  Marin     Mariposa Mendocino   Merced      Modoc  Mono   Monterey  Napa      Nevada      Orange      Placer      Plumas   Riverside      Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 129 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Outpatient Mental Health Services County la u d iv id n I y p a re h T p u o rG y p a re h T n o ita c id e M tro p p u S s is irC n o itn e v re tn I e s a C tn e m e g a n a M Sacramento      San Benito      San Bernardino      San Diego     San Francisco      San Joaquin      San Luis Obispo     San Mateo      Santa Barbara      Santa Clara     Santa Cruz  Shasta    Sierra    Siskiyou   Solano   Sonoma     Stanislaus      Sutter-Yuba      Tehama   Tri-City  Trinity   Tulare    Tuolumne      Ventura     Yolo TOTAL 30 30 37 43 48 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 130 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.24 Counties Reporting Planned Implementation of Full Service Partnership Services to Adults (N=59) Other Supports County la tn e m u rts n I s d e e N fo ts o C e ra c h tla e H tn e m ta e rT s e c iv re S e tip s e R d e tro p p u S / tn e m y o lp m E n o ita c u d E o h c y s P - n o ita c u d e y lim a F n o ita c u d E / la n o ita c u d E tn e m y o lp m E s e ilp p u S la n o ita e rc e R s e itiv itc A n o ita tro p s n a rT g n itn e ra P n o ita c u d E e ta m itn I re n tra P e c n e lo iV s e c iv re S Alameda   Alpine   Amador Berkeley City     Butte   Calaveras    Colusa  Contra Costa      Del Norte El Dorado      Fresno      Glenn         Humboldt Imperial       Inyo      Kern       Kings  Lake          Lassen Los Angeles        Madera    Marin    Mariposa     Mendocino  Merced      Modoc  Mono        Monterey    Napa            Nevada      Orange        Placer    Plumas      Riverside       Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 131 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Other Supports County la tn e m u rts n I s d e e N fo ts o C e ra c h tla e H tn e m ta e rT s e c iv re S e tip s e R d e tro p p u S / tn e m y o lp m E n o ita c u d E o h c y s P - n o ita c u d e y lim a F n o ita c u d E / la n o ita c u d E tn e m y o lp m E s e ilp p u S la n o ita e rc e R s e itiv itc A n o ita tro p s n a rT g n itn e ra P n o ita c u d E e ta m itn I re n tra P e c n e lo iV s e c iv re S Sacramento       San Benito      San Bernardino        San Diego    San Francisco   San Joaquin     San Luis Obispo     San Mateo           Santa Barbara            Santa Clara    Santa Cruz Shasta            Sierra      Siskiyou    Solano  Sonoma   Stanislaus      Sutter-Yuba          Tehama  Tri-City  Trinity    Tulare     Tuolumne           Ventura      Yolo   TOTAL 33 9 12 11 33 32 30 28 39 14 11 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 132 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.25 Counties Reporting Planned Implementation of Full Service Partnership Services – Peer Support – Specific Positions for Peers for Adults (N=59) Peer Support Services / County re e P / s ro tn e M t n e m ts u jd A s e h c a o C s e h c a o C b o J la n o ita c u d E s ro t u T / s e h c a o C s re g a n a M e s a C s ro ta c u d E tn e ra P p u o rG tro p p u S s ro ta c u d E re e P s e ta c o v d A Alameda    Alpine    Amador     Berkeley City     Butte    Calaveras  Colusa   Contra Costa   Del Norte     El Dorado     Fresno    Glenn        Humboldt  Imperial       Inyo     Kern      Kings   Lake     Lassen  Los Angeles     Madera Marin      Mariposa Mendocino   Merced    Modoc   Mono  Monterey      Napa      Nevada      Orange     Placer   Plumas Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 133 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Peer Support Services / County re e P / s ro tn e M t n e m ts u jd A s e h c a o C s e h c a o C b o J la n o ita c u d E s ro t u T / s e h c a o C s re g a n a M e s a C s ro ta c u d E tn e ra P p u o rG tro p p u S s ro ta c u d E re e P s e ta c o v d A Riverside      Sacramento       San Benito        San Bernardino       San Diego      San Francisco     San Joaquin   San Luis Obispo    San Mateo       Santa Barbara      Santa Clara  Santa Cruz    Shasta    Sierra     Siskiyou  Solano    Sonoma    Stanislaus     Sutter-Yuba       Tehama      Tri-City    Trinity     Tulare    Tuolumne   Ventura     Yolo   TOTAL 38 25 22 14 19 47 36 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 134 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.26 Counties Reporting Planned Implementation of Full Service Partnership Services – Peer Support – Strategies where Peers are part of Team for Adult (N=59) Peer Support Services n County e s u o h b u lC / s re tn p e o C r n D -i s e n iL m ra W d t n n a e h m c e a g e a rt g u n O E s e itiv it c A n o ita e rc e R / la ic o S tro p p u S e ra C d lih C n o ita tro p s n a rT tro p p u S g n is u o H fle s ,.g .e ( s e , s p s l a e l h C - )tn e m e g a n a m y a d y re v e ,.g .e ( tro p p u S la tn e m u rts n I y re c o rg ,g n ip e e k e s u o h )s d e e n la re n e g ,g n ip p o h s y tilic a F / g n ip e e K s d n u o rG e c n a n e tn ia M tro p p u S e m o n H - I e ra C e tip s e R n o itn e v re tn I s is irC n o ita tilib a h e R o itn e v re t n I a m u a rT / e c n e lo iV Alameda  Alpine    Amador      Berkeley City  Butte        Calaveras     Colusa  Contra Costa   Del Norte      El Dorado     Fresno     Glenn         Humboldt  Imperial          Inyo    Kern     Kings    Lake       Lassen  Los Angeles     Madera    Marin     Mariposa Mendocino      Merced   Modoc     Mono Monterey     Napa           Nevada  Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 135 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Peer Support Services n County e s u o h b u lC / s re tn p e o C r n D -i s e n iL m ra W d t n n a e h m c e a g e a rt g u n O E s e itiv it c A n o ita e rc e R / la ic o S tro p p u S e ra C d lih C n o ita tro p s n a rT tro p p u S g n is u o H fle s ,.g .e ( s e , s p s l a e l h C - )tn e m e g a n a m y a d y re v e ,.g .e ( tro p p u S la tn e m u rts n I y re c o rg ,g n ip e e k e s u o h )s d e e n la re n e g ,g n ip p o h s y tilic a F / g n ip e e K s d n u o rG e c n a n e tn ia M tro p p u S e m o n H - I e ra C e tip s e R n o itn e v re tn I s is irC n o ita tilib a h e R o itn e v re t n I a m u a rT / e c n e lo iV Orange    Placer   Plumas  Riverside      Sacramento       San Benito       San Bernardino         San Diego         San Francisco      San Joaquin     San Luis Obispo    San Mateo      Santa Barbara             Santa Clara    Santa Cruz Shasta      Sierra     Siskiyou Solano Sonoma  Stanislaus       Sutter-Yuba         Tehama    Tri-City Trinity    Tulare  Tuolumne       Ventura      Yolo  TOTAL 27 15 38 34 3 22 21 25 7 1 5 2 10 10 2 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 136 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.27 Counties Reporting Planned Implementation of Full Service Partnership Services – Peer Support – Peers Augmenting the Overall Capacity of the Staff Team for Adult (N=59) Peer Support Services County t s ro p p u p o u rG S y lla ru tlu C lliF / tn e te p m o C s e itira p s iD c in h tE Q T G B L d n a la c in ilC tro p p u S re e P / y lim a F ffa tS e c n e ire p x E re m u s n o C )y ro ts rie h t e ra h s ( h tiw n o ita ro b a llo C / s e ic n e g A re h tO y tin u m m o C d n a tn e m tiu rc e R g n iriH s llik S n o ita z ila ic o S s llik S n o ita c in u m m o C Alameda   Alpine       Amador        Berkeley City      Butte       Calaveras   Colusa   Contra Costa   Del Norte     El Dorado      Fresno     Glenn      Humboldt    Imperial       Inyo     Kern     Kings  Lake       Lassen     Los Angeles    Madera      Marin    Mariposa  Mendocino     Merced    Modoc   Mono   Monterey       Napa      Nevada       Orange      Placer Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 137 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Peer Support Services County t s ro p p u p o u rG S y lla ru tlu C lliF / tn e te p m o C s e itira p s iD c in h tE Q T G B L d n a la c in ilC tro p p u S re e P / y lim a F ffa tS e c n e ire p x E re m u s n o C )y ro ts rie h t e ra h s ( h tiw n o ita ro b a llo C / s e ic n e g A re h tO y tin u m m o C d n a tn e m tiu rc e R g n iriH s llik S n o ita z ila ic o S s llik S n o ita c in u m m o C Plumas  Riverside       Sacramento       San Benito       San Bernardino      San Diego       San Francisco      San Joaquin    San Luis Obispo  San Mateo          Santa Barbara          Santa Clara    Santa Cruz    Shasta       Sierra     Siskiyou Solano  Sonoma    Stanislaus      Sutter-Yuba     Tehama  Tri-City   Trinity   Tulare    Tuolumne    Ventura    Yolo  TOTAL 47 40 9 38 9 38 30 10 3 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 138 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.28 Counties Reporting Planned Implementation of Full Service Partnership Services to Adults: Housing (N=59) g g n n is is u u County o County o H H Alameda  Orange  Alpine  Placer  Amador Plumas  Berkeley City Riverside  Butte  Sacramento  Calaveras  San Benito  Colusa  San Bernardino  Contra Costa  San Diego  Del Norte  San Francisco  El Dorado  San Joaquin  Fresno  San Luis Obispo  Glenn  San Mateo  Humboldt  Santa Barbara  Imperial  Santa Clara  Inyo  Santa Cruz  Kern  Shasta  Kings  Sierra  Lake  Siskiyou  Lassen  Solano Los Angeles  Sonoma  Madera  Stanislaus  Marin  Sutter-Yuba  Mariposa  Tehama Mendocino  Tri-City  Merced  Trinity  Modoc  Tulare  Mono  Tuolumne  Monterey  Ventura  Napa  Yolo  Nevada  TOTAL 56 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 139 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.29 Counties Reporting Planned Implementation of Full Service Partnership Services to Adults (N=59) MH Staff SA Tx County fo re b m u N / ts irta ih c y s P ffa tS P N la ic o S fo re b m u N ffa tS re k ro W h c a o rp p A m a e T e s u b A e c n a ts b u S tn e m ta e rT Alameda     Alpine Amador  Berkeley City Butte     Calaveras    Colusa   Contra Costa     Del Norte  El Dorado  Fresno     Glenn     Humboldt  Imperial    Inyo  Kern     Kings Lake   Lassen  Los Angeles    Madera  Marin    Mariposa   Mendocino Merced   Modoc   Mono   Monterey   Napa     Nevada    Orange   Placer    Plumas  Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 140 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets MH Staff SA Tx County fo re b m u N / ts irta ih c y s P ffa tS P N la ic o S fo re b m u N ffa tS re k ro W h c a o rp p A m a e T e s u b A e c n a ts b u S tn e m ta e rT Riverside   Sacramento  San Benito     San Bernardino    San Diego    San Francisco    San Joaquin    San Luis Obispo     San Mateo     Santa Barbara     Santa Clara    Santa Cruz  Shasta     Sierra    Siskiyou   Solano Sonoma  Stanislaus     Sutter-Yuba   Tehama    Tri-City  Trinity  Tulare   Tuolumne     Ventura     Yolo   TOTAL 31 26 32 49 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 141 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.30 Counties Reporting Planned Implementation of Full Service Partnership Services to Adults (n=59) Other Disch- Evidence-Based Practices Practices Coordination arge County y re v o c e R s s e n lle W n a lP n o itc A e v itin g o C y p a re h T la ro iv a h e B la c itc e la iD r y o p iv a a r h e e h B T s llik S la ic o S g n in ia rT y p a re h T ro iv a h e B g n ile d o M y lim a F a c u d e o h c n y o s i P t- e ra C n i s re n tra P e v ita n re tlA tn e m ta e rT y l l c a i r fi u c t e lu p C S -tn e m ta e rT la tip s o H n o ita n id ro o C e c its u J la n im irC n o ita n id ro o C a ire tirC / g n in n a lP Alameda    Alpine  Amador  Berkeley City    Butte   Calaveras    Colusa  Contra Costa     Del Norte       El Dorado   Fresno       Glenn           Humboldt  Imperial    Inyo     Kern        Kings    Lake      Lassen  Los Angeles       Madera     Marin    Mariposa   Mendocino  Merced  Modoc Mono  Monterey     Napa       Nevada         Orange       Placer Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 142 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Other Disch- Practices Coordination arge Evidence-Based Practices County y re v o c e R s s e n lle W n a lP n o itc A e v itin g o C y p a re h T la ro iv a h e B la c itc e la iD r y o p iv a a r h e e h B T s llik S la ic o S g n in ia rT y p a re h T ro iv a h e B g n ile d o M y lim a F a c u d e o h c n y o s i P t- e ra C n i s re n tra P e v ita n re tlA tn e m ta e rT y l l c a i r fi u c t e lu p C S -tn e m ta e rT la tip s o H n o ita n id ro o C e c its u J la n im irC n o ita n id ro o C a ire tirC / g n in n a lP Plumas Riverside          Sacramento       San Benito           San Bernardino        San Diego   San Francisco   San Joaquin    San Luis Obispo   San Mateo           Santa Barbara              Santa Clara     Santa Cruz   Shasta       Sierra      Siskiyou Solano  Sonoma   Stanislaus      Sutter-Yuba          Tehama Tri-City   Trinity   Tulare   Tuolumne            Ventura       Yolo  TOTAL 40 12 6 14 10 5 20 1 13 23 24 37 26 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 143 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.31 Counties Reporting Planned Implementation of Full Service Partnership Services to Older Adults (N=54) Outreach and Engagement County o t h c a e rtu O & d e v re s re d n U d e v re s n U o t y tiro irP d e v re s n U s n o ita lu p o P P S F ra e lC a ire tirC y tilib ig ilE s d e e N tn e m s s e s s A la u d iv id n I s e c iv re & S n a lP s tro p p u S y re v ile D e c iv re S s d e e N n o d e s a b & tn e m s s e s s A P S S I Alameda       Alpine      Amador     Berkeley City      Butte       Calaveras    Colusa* Contra Costa* Del Norte* El Dorado   Fresno     Glenn       Humboldt       Imperial       Inyo      Kern       Kings    Lake       Lassen   Los Angeles       Madera   Marin       Mariposa  Mendocino     Merced     Modoc     Mono* Monterey     Napa       Nevada      Orange     Placer       Plumas       Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 144 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Outreach and Engagement County o t h c a e rtu O & d e v re s re d n U d e v re s n U o t y tiro irP d e v re s n U s n o ita lu p o P P S F ra e lC a ire tirC y tilib ig ilE s d e e N tn e m s s e s s A la u d iv id n I s e c iv re & S n a lP s tro p p u S y re v ile D e c iv re S s d e e N n o d e s a b & tn e m s s e s s A P S S I Riverside     Sacramento      San Benito       San Bernardino       San Diego       San Francisco       San Joaquin       San Luis Obispo       San Mateo       Santa Barbara       Santa Clara      Santa Cruz     Shasta       Sierra* Siskiyou    Solano    Sonoma    Stanislaus       Sutter-Yuba       Tehama     Tri-City     Trinity   Tulare     Tuolumne       Ventura    Yolo    TOTAL 51 45 44 43 40 29 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for OA in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 145 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.32 Counties Reporting Planned Implementation of Full Service Partnership Services to Older Adults (N=54) Personal Services General Standards Coordinator County d a o le s a C w o L e g a re v o C 7 / 4 2 y tin u m m o C n i s e c iv re S c in ilC e h t .v ,y re v o c e R ,s s e n lle W e c n e ilis e R e ra C d e re tn tn e e ilC C - e ra C d e r y e li t m n e a C F - e c n e l t a e r p u m tl o u C C y tin u m m o C n o ita ro b a llo C e c iv re S d e ta rg e tn I e c n e ire p x E Alameda          Alpine          Amador   Berkeley City         Butte        Calaveras       Colusa* Contra Costa* Del Norte* El Dorado  Fresno       Glenn          Humboldt          Imperial        Inyo        Kern         Kings       Lake          Lassen        Los Angeles        Madera        Marin        Mariposa      Mendocino       Merced         Modoc        Mono* Monterey      Napa         Nevada          Orange        Placer         Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 146 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Personal Services General Standards Coordinator County d a o le s a C w o L e g a re v o C 7 / 4 2 y tin u m m o C n i s e c iv re S c in ilC e h t .v ,y re v o c e R ,s s e n lle W e c n e ilis e R e ra C d e re tn tn e e ilC C - e ra C d e r y e li t m n e a C F - e c n e l t a e r p u m tl o u C C y tin u m m o C n o ita ro b a llo C e c iv re S d e ta rg e tn I e c n e ire p x E Plumas      Riverside        Sacramento       San Benito          San Bernardino         San Diego          San Francisco         San Joaquin        San Luis Obispo         San Mateo          Santa Barbara          Santa Clara       Santa Cruz     Shasta         Sierra* Siskiyou       Solano   Sonoma         Stanislaus          Sutter-Yuba         Tehama          Tri-City         Trinity   Tulare       Tuolumne          Ventura        Yolo       TOTAL 35 44 38 54 36 34 51 44 45 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for OA in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 147 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.33 Counties Reporting Planned Implementation of Full Service Partnership Services to Older Adults (N=54) Outpatient Mental Health Services County la u d iv id n I y p a re h T p u o rG y p a re h T n o ita c id e M tro p p u S s is irC n o itn e v re tn I e s a C tn e m e g a n a M Alameda  Alpine    Amador  Berkeley City  Butte    Calaveras  Colusa* Contra Costa* Del Norte* El Dorado Fresno   Glenn      Humboldt    Imperial   Inyo   Kern      Kings    Lake    Lassen Los Angeles      Madera    Marin    Mariposa Mendocino Merced      Modoc  Mono* Monterey  Napa      Nevada      Orange      Placer      Plumas  Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 148 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Outpatient Mental Health Services County la u d iv id n I y p a re h T p u o rG y p a re h T n o ita c id e M tro p p u S s is irC n o itn e v re tn I e s a C tn e m e g a n a M Riverside Sacramento      San Benito      San Bernardino      San Diego      San Francisco      San Joaquin      San Luis Obispo    San Mateo      Santa Barbara      Santa Clara     Santa Cruz   Shasta    Sierra* Siskiyou  Solano    Sonoma     Stanislaus      Sutter-Yuba      Tehama   Tri-City  Trinity Tulare    Tuolumne      Ventura   Yolo  TOTAL 26 25 35 41 31 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for OA in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 149 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.34 Counties Reporting Planned Implementation of Full Service Partnership Services to Older Adults (N=54) Other Supports County la tn e m u rts n I s d e e N e ra c h tla e H fo ts o C tn e m ta e rT s e c iv re S e tip s e R d e tro p p u S / tn e m y o lp m E n o ita c u d E n o i o ta h c c u y d s P e - n o ita c u d E y lim a F / la n o ita c u d E tn e m y o lp m E s e ilp p u S la n o ita e rc e R s e itiv itc A n o ita tro p s n a rT re n t ra P e ta m itn I s e c iv re S e c n e lo iV Alameda  Alpine   Amador Berkeley City    Butte   Calaveras    Colusa* Contra Costa* Del Norte* El Dorado  Fresno   Glenn       Humboldt Imperial     Inyo    Kern      Kings  Lake          Lassen Los Angeles      Madera      Marin    Mariposa     Mendocino Merced      Modoc  Mono* Monterey Napa           Nevada    Orange      Placer    Plumas       Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 150 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Other Supports County la tn e m u rts n I s d e e N e ra c h tla e H fo ts o C tn e m ta e rT s e c iv re S e tip s e R d e tro p p u S / tn e m y o lp m E n o ita c u d E n o i o ta h c c u y d s P e - n o ita c u d E y lim a F / la n o ita c u d E tn e m y o lp m E s e ilp p u S la n o ita e rc e R s e itiv itc A n o ita tro p s n a rT re n t ra P e ta m itn I s e c iv re S e c n e lo iV Riverside  Sacramento      San Benito     San Bernardino       San Diego      San Francisco    San Joaquin      San Luis Obispo      San Mateo           Santa Barbara           Santa Clara     Santa Cruz Shasta           Sierra* Siskiyou    Solano    Sonoma   Stanislaus      Sutter-Yuba        Tehama    Tri-City   Trinity Tulare     Tuolumne          Ventura   Yolo      TOTAL 28 8 16 8 27 28 24 23 34 11 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for OA in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 151 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.35 Counties Reporting Planned Implementation of Full Service Partnership Services – Peer Support – Specific Positions for Peers for Older Adults (N=54) Peer Support Services / County re e P / s ro tn e M t n e m ts u jd A s e h c a o C s e h c a o C b o J la n o ita c u d E s ro t u T / s e h c a o C s re g a n a M e s a C s ro ta c u d E tn e ra P p u o rG tro p p u S s ro ta c u d E re e P s e ta c o v d A Alameda   Alpine    Amador   Berkeley City     Butte    Calaveras  Colusa* Contra Costa* Del Norte* El Dorado    Fresno     Glenn    Humboldt  Imperial      Inyo   Kern      Kings   Lake     Lassen  Los Angeles     Madera Marin      Mariposa Mendocino    Merced    Modoc   Mono* Monterey     Napa    Nevada      Orange   Placer     Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 152 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Peer Support Services / County re e P / s ro tn e M t n e m ts u jd A s e h c a o C s e h c a o C b o J la n o ita c u d E s ro t u T / s e h c a o C s re g a n a M e s a C s ro ta c u d E tn e ra P p u o rG tro p p u S s ro ta c u d E re e P s e ta c o v d A Plumas Riverside      Sacramento       San Benito        San Bernardino   San Diego       San Francisco      San Joaquin    San Luis Obispo    San Mateo      Santa Barbara      Santa Clara    Santa Cruz   Shasta    Sierra* Siskiyou   Solano      Sonoma     Stanislaus      Sutter-Yuba       Tehama      Tri-City    Trinity  Tulare    Tuolumne   Ventura      Yolo   TOTAL 39 18 18 13 15 47 28 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for OA in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 153 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.36 Counties Reporting Planned Implementation of Full Service Partnership Services – Peer Support – Strategies where Peers are part of Team for Older Adult (N=54) Peer Support Services y ,g County e s u o h b u lC / s re tn p e o C r n D -i s e n iL m ra W tn e m e g a g n E d n a h c a e rtu O s e itiv it c A n o ita e rc e R / la ic o S tro p p u S e ra C d lih C n o ita tro p s n a rT tro p p u S g n is u o H fle s a , d .g y . r e e ( v s e e , s p s l a e l h C - )tn e m e g a n a m ,.g .e ( tro p p u S la tn e m u rts n I n ip p o h s y re c o rg ,g n ip e e k e s u o h )s d e e n la re n e g y tilic a F / g n ip e e K s d n u o rG e c n a n e tn ia M tro p p u S e m o n H - I e ra C e tip s e R n o itn e v re tn I s is irC n o ita tilib a h e R n o itn e v re t n I a m u a rT / e c n e lo iV Alpine      Alameda Amador   Berkeley City  Butte        Calaveras      Colusa* Contra Costa* Del Norte* El Dorado     Fresno     Glenn       Humboldt  Imperial         Inyo Kern     Kings    Lake        Lassen  Los Angeles  Madera   Marin     Mariposa Mendocino      Merced     Modoc      Mono* Monterey    Napa          Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 154 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Peer Support Services y ,g County e s u o h b u lC / s re tn p e o C r n D -i s e n iL m ra W tn e m e g a g n E d n a h c a e rtu O s e itiv it c A n o ita e rc e R / la ic o S tro p p u S e ra C d lih C n o ita tro p s n a rT tro p p u S g n is u o H fle s a , d .g y . r e e ( v s e e , s p s l a e l h C - )tn e m e g a n a m ,.g .e ( tro p p u S la tn e m u rts n I n ip p o h s y re c o rg ,g n ip e e k e s u o h )s d e e n la re n e g y tilic a F / g n ip e e K s d n u o rG e c n a n e tn ia M tro p p u S e m o n H - I e ra C e tip s e R n o itn e v re tn I s is irC n o ita tilib a h e R n o itn e v re t n I a m u a rT / e c n e lo iV Nevada  Orange      Placer   Plumas  Riverside      Sacramento      San Benito      San Bernardino     San Diego          San Francisco      San Joaquin     San Luis Obispo    San Mateo        Santa Barbara             Santa Clara  Santa Cruz Shasta      Sierra* Siskiyou    Solano  Sonoma  Stanislaus       Sutter-Yuba          Tehama    Tri-City Trinity  Tulare   Tuolumne      Ventura     Yolo   TOTAL 24 14 38 30 1 23 19 21 11 2 8 2 11 6 2 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for OA in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 155 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.37 Counties Reporting Planned Implementation of Full Service Partnership Services – Peer Support – Peers Augmenting the Overall Capacity of the Staff Team for Older Adult (N=54) Peer Support Services County s p u o rG tro p p u S y lla ru tlu C lliF / tn e te p m o C s e itira p s iD c in h tE Q T G B L d n a la c in ilC tro p p u S re e P / y lim a F ffa tS e c n e ire p x E re m u s n o C )y ro ts rie h t e ra h s ( h tiw n o ita ro b a llo C / s e ic n e g A re h tO y tin u m m o C d n a tn e m tiu rc e R g n iriH s llik S n o ita z ila ic o S s llik S n o ita c in u m m o C Alameda   Alpine       Amador   Berkeley City      Butte      Calaveras* Colusa* Contra Costa* Del Norte  El Dorado      Fresno     Glenn      Humboldt    Imperial      Inyo  Kern     Kings  Lake       Lassen     Los Angeles    Madera      Marin    Mariposa  Mendocino     Merced    Modoc  Mono* Monterey      Napa       Nevada       Orange     Placer    Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 156 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Peer Support Services County s p u o rG tro p p u S y lla ru tlu C lliF / tn e te p m o C s e itira p s iD c in h tE Q T G B L d n a la c in ilC tro p p u S re e P / y lim a F ffa tS e c n e ire p x E re m u s n o C )y ro ts rie h t e ra h s ( h tiw n o ita ro b a llo C / s e ic n e g A re h tO y tin u m m o C d n a tn e m tiu rc e R g n iriH s llik S n o ita z ila ic o S s llik S n o ita c in u m m o C Plumas  Riverside      Sacramento       San Benito      San Bernardino     San Diego       San Francisco       San Joaquin    San Luis Obispo  San Mateo          Santa Barbara          Santa Clara      Santa Cruz    Shasta       Sierra* Siskiyou   Solano    Sonoma      Stanislaus      Sutter-Yuba     Tehama  Tri-City   Trinity   Tulare    Tuolumne    Ventura   Yolo TOTAL 44 36 8 33 7 37 26 11 3 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for OA in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 157 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.38 Counties Reporting Planned Implementation of Full Service Partnership Services to Older Adults: Housing (N=54) g g n n is is u u County o County o H H Alameda  Orange  Alpine  Placer  Amador Plumas  Berkeley City Riverside Butte  Sacramento  Calaveras San Benito  Colusa* San Bernardino  Contra Costa* San Diego  Del Norte* San Francisco  El Dorado  San Joaquin  Fresno San Luis Obispo  Glenn  San Mateo  Humboldt  Santa Barbara  Imperial  Santa Clara  Inyo  Santa Cruz  Kern Shasta  Kings  Sierra* Lake  Siskiyou  Lassen  Solano  Los Angeles  Sonoma  Madera  Stanislaus  Marin  Sutter-Yuba  Mariposa  Tehama Mendocino Tri-City  Merced  Trinity Modoc  Tulare  Mono* Tuolumne  Monterey  Ventura Napa  Yolo Nevada  TOTAL 43 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for OA in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 158 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Impact on Expenditures and Cost Offsets Table B.39 Counties Reporting Planned Implementation of Full Service Partnership Services to Older Adults (N=54) MH Staff SA Tx County fo re b m u N / ts irta ih c y s P ffa tS P N la ic o S fo re b m u N ffa tS re k ro W h c a o rp p A m a e T e s u b A e c n a ts b u S tn e m ta e rT Alameda     Alpine Amador  Berkeley City Butte     Calaveras   Colusa* Contra Costa* Del Norte* El Dorado Fresno     Glenn     Humboldt  Imperial   Inyo Kern     Kings  Lake    Lassen  Los Angeles    Madera   Marin     Mariposa   Mendocino  Merced   Modoc    Mono* Monterey    Napa    Nevada     Orange    Placer   Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 159 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets MH Staff SA Tx County fo re b m u N / ts irta ih c y s P ffa tS P N la ic o S fo re b m u N ffa tS re k ro W h c a o rp p A m a e T e s u b A e c n a ts b u S tn e m ta e rT Plumas  Riverside  Sacramento   San Benito     San Bernardino     San Diego    San Francisco    San Joaquin    San Luis Obispo    San Mateo     Santa Barbara     Santa Clara   Santa Cruz Shasta     Sierra* Siskiyou   Solano Sonoma  Stanislaus     Sutter-Yuba   Tehama     Tri-City  Trinity Tulare   Tuolumne     Ventura    Yolo  TOTAL 33 23 31 38 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for OA in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 160 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table B.40 Counties Reporting Planned Implementation of Full Service Partnership Services to Older Adults (n=54) Other Dis- Evidence-Based Practices Coordination Practices charge County y re v o c e R s s e n lle W n a lP n o itc A la ro iv a h e B e v itin g o C y p a re h T ro iv a h e B la c itc e la iD y p a re h T g n in ia rT s llik S la ic o S y p a re h T ro iv a h e B g n ile d o M y lim a F n o ita c u d e o h c y s P e ra C n i s re n tra P tn e m ta e rT e v ita n re tlA y l l c a i r fi u c t e lu p C S -tn e m ta e rT n o ita n id ro o C la tip s o H e c its u J la n im irC n o ita n id ro o C a ire tirC / g n in n a lP Alameda  Alpine  Amador  Berkeley City      Butte   Calaveras     Colusa* Contra Costa* Del Norte* El Dorado Fresno      Glenn           Humboldt  Imperial   Inyo    Kern        Kings    Lake      Lassen  Los Angeles     Madera     Marin    Mariposa   Mendocino Merced  Modoc Mono* Monterey  Napa        Nevada       Orange    Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 161 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Other Dis- Evidence-Based Practices Coordination Practices charge County y re v o c e R s s e n lle W n a lP n o itc A la ro iv a h e B e v itin g o C y p a re h T ro iv a h e B la c itc e la iD y p a re h T g n in ia rT s llik S la ic o S y p a re h T ro iv a h e B g n ile d o M y lim a F n o ita c u d e o h c y s P e ra C n i s re n tra P tn e m ta e rT e v ita n re tlA y l l c a i r fi u c t e lu p C S -tn e m ta e rT n o ita n id ro o C la tip s o H e c its u J la n im irC n o ita n id ro o C a ire tirC / g n in n a lP Placer Plumas Riverside Sacramento       San Benito           San Bernardino        San Diego   San Francisco San Joaquin    San Luis Obispo  San Mateo           Santa Barbara              Santa Clara  Santa Cruz Shasta       Sierra* Siskiyou Solano  Sonoma    Stanislaus       Sutter-Yuba        Tehama Tri-City    Trinity Tulare   Tuolumne            Ventura    Yolo TOTAL 22 7 4 10 9 4 19 1 11 22 23 27 19 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for OA in study Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 162 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Appendix C County FSP Expenditure by Age Group Web Survey (Table View – what the tables look like before we download the data) Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 163 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets County FSP Expenditure by Age Group Web Survey RespondentID Please enter county name: Open-Ended Response Please enter county code: Open-Ended Response Where did your county/municipality document FSP Housing Expenditures on the FY 08-09 Revenue & Expenditure Reports: GSD Housing GSD Operating FSP Operating Outreach & Engagement Operating Administrative: Operating Outside of the MHSA Housing Program None of these – Another line item If you indicated “None of these – Another line item”, please specify. What amount of expenditures in this line item for FY 08-09 is devoted to FSP Housing? GSD Housing GSD Operating FSP Operating Outreach & Engagement Operating Administrative: Operating None of these – Another line item What percentage of expenditures in this line item for FY 08-09 is devoted to FSP Housing? (Please have total equal 100%) GSD Housing GSD Operating FSP Operating Outreach & Engagement Operating Administrative: Operating None of these – Another line item What % of monies from the “GSD Housing” source of FSP Housing in FY 08- 09 was expended on each age group: (Please have total equal 100%) Children TAY Adults Older Adults What % of monies from the “GSD Operating” source of FSP Housing in FY 08-09 was expended on each age group: (Please have total equal 100%) Children TAY Adults Older Adults Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 164 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets What % of monies from the “FSP Operating” source of FSP Housing in FY 09-10 was expended on each age group: (Please have total equal 100%) Children TAY Adults Older Adults What % of monies from the “Outreach & Engagement Operating” source of FSP Housing in FY 08-09 was expended on each age group: (Please have total equal 100%) Children TAY Adults Older Adults What % of monies from the “Administrative - Operating” source of FSP Housing in FY 08-09 was expended on each age group: (Please have total equal 100%) Children TAY Adults Older Adults What % of monies from the “Other” source of FSP Housing in FY 08-09 was expended on each age group: (Please have total equal 100%) Children TAY Adults Older Adults Where did your county/municipality document FSP Housing Expenditures on the FY 09-10 Revenue & Expenditure Reports? GSD Housing GSD Operating FSP Operating Outreach & Engagement Operating Administrative: Operating Outside of the MHSA Housing Program None of these – Another line item If you indicated “None of these – Another line item”, please specify. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 165 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets What amount of expenditures in this line item in FY 09-10 is devoted to FSP Housing? GSD Housing GSD Operating FSP Operating Outreach & Engagement Operating Administrative: Operating None of these – Another line item What percentage of expenditures in this line item in FY 09-10 is devoted to FSP Housing? (Please have total equal 100%) GSD Housing GSD Operating FSP Operating Outreach & Engagement Operating Administrative: Operating None of these – Another line item What % of monies from the “GSD Housing” source of FSP Housing in FY 09- 10 was expended on each age group: (Please have total equal 100%) Children TAY Adults Older Adults What % of monies from the “GSD Operating” source of FSP Housing in FY 09-10 was expended on each age group: (Please have total equal 100%) Children TAY Adults Older Adults What % of monies from the “FSP Operating” source of FSP Housing in FY 09-10 was expended on each age group: (Please have total equal 100%) Children TAY Adults Older Adults What % of monies from the “Outreach & Engagement Operating” source of FSP Housing in FY 08-09 was expended on each age group: (Please have total equal 100%) Children TAY Adults Older Adults Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 166 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets What % of monies from the “Administrative - Operating” source of FSP Housing in FY 08-09 was expended on each age group: (Please have total equal 100%) Children TAY Adults Older Adults What % of monies from the “Other” source of FSP Housing in FY 08-09 was expended on each age group: (Please have total equal 100%) Children TAY Adults Older Adults How many programs FY 08-09 are devoted to outreach to FSPs? 0 Programs 1-10 Programs What amount of expenditures in this program for FY 08-09 is devoted to outreach to FSPs? Program 1 Program 2 Program 3 Program 4 Program 5 Program 6 Program 7 Program 8 Program 9 Program 10 What % of monies for outreach in “Program 1” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 2” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 3” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 167 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Adults Older Adults What % of monies for outreach in “Program 4” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 5” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 6” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 7” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 8” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 9” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 10” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 168 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Older Adults How many programs FY 09-10 are devoted to outreach to FSPs? 0 Programs 1-10 Programs What amount of expenditures in this program for FY 09-10 is devoted to outreach to FSPs? Program 1 Program 2 Program 3 Program 4 Program 5 Program 6 Program 7 Program 8 Program 9 Program 10 What % of monies for outreach in “Program 1” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 2” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 3” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 4” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 5” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 169 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Older Adults What % of monies for outreach in “Program 6” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 7” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 8” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 9” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for outreach in “Program 10” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults How many programs for FY 08-09 are devoted to supportive services for FSPs? 0 Programs 1-10 Programs What amount of expenditures in this program for FY 08-09 is devoted to supportive services for FSPs? Program 1 Program 2 Program 3 Program 4 Program 5 Program 6 Program 7 Program 8 Program 9 Program 10 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 170 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets What % of monies for supportive services in “Program 1” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for supportive services in “Program 2” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for supportive services in “Program 3” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for supportive services in “Program 4” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for supportive services in “Program 5” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for supportive services in “Program 6” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for supportive services in “Program 7” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 171 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets What % of monies for supportive services in “Program 8” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for supportive services in “Program 9” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for supportive services in “Program 10” in FY 08-09 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults How many programs for FY 09-10 are devoted to supportive services for FSPs? 0 Programs 1-10 Programs What amount of expenditures in this program for FY 09-10 is devoted to supportive services for FSPs? Program 1 Program 2 Program 3 Program 4 Program 5 Program 6 Program 7 Program 8 Program 9 Program 10 What % of monies for supportive services in “Program 1” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 172 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets What % of monies for supportive services in “Program 2” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for supportive services in “Program 3” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for supportive services in “Program 4” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for supportive services in “Program 5” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for supportive services in “Program 6” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for supportive services in “Program 7” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 173 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets What % of monies for supportive services in “Program 8” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for supportive services in “Program 9” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults What % of monies for supportive services in “Program 10” in FY 09-10 was expended on FSPs in each age group: (Please have total equal 100%) Children, Youth & Families TAY Adults Older Adults Please provide any comments or notes you may have for UCLA. Open-Ended Response Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 174 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets FSP Services Assessment Tool YES/NO CYF TAY AD OA 1 Outreach to Underserved and Unserved Communities 2 Priority to Unserved Populations 3 FSP Eligibility (criteria) 3 Needs Assessment 3 Individual Services & Supports Plan 3 Service Delivery based on Needs Assessment & ISSP 4 Low Caseload 4 Consumer/Family Staff 4 24/7 Coverage 4 Services in Community v. in the Clinic 5 Client Centered Care 5 Family Centered Care 5 Culturally Appropriate 5 Collaboration with Community Services 5 Integrated Service Delivery 6 Individual Therapy 6 Group Therapy 6 Medication Support 6 Crisis Intervention 6 Employment Case Management 6 Medical Case Management 6 Social Case Management 6 Rehabilitative Case Management 6 Educational Case Management 6 Community Client Services 7 Case Management Support 7 Housing Case Management 7 Psychoeducation 7 Family Education 8 Instrumental Needs 8 Cost of Health Care Treatment 8 Respite Care Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 175 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets HOUSING YES/NO CYF TAY AD OA 9 Housing Supports 9 Operating Support 9 Housing Placement YES/NO CYF TAY AD OA 10 Psychiatrist/NP staff 10 Social Worker staff 10 Team Approach 11 Educational/Employment Supplies 11 Recreational Activities 11 Transportation 12 Education/Employment Case Management 12 Recreational Case Management 12 Parenting Education 12 Intimate Partner Violence Services 13 Substance Abuse Treatment 14 Wellness Recovery Action Plan 14 Cognitive Behavioral Therapy 14 Dialectical Behavior Therapy 14 Social Skills Training 14 Behavior Therapy 14 Modeling 14 Family Psychoeducation 14 Partners in Care 14 IMPACT (Improving Mood--Promoting Access to Collaborative Treatment) 14 Multisystemic Therapy 14 Therapeutic Foster Care 14 Psychoeducational Multi-Family Groups 14 Parent-Child Interaction Therapy 14 Wraparound 15 Alternative Treatment 15 Culturally Specific 16 Coordination w/Hospital 16 Coordination w/Criminal Justice 17 Discharge Planning / Criteria Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 176 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Appendix D County Participants Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 177 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 233 Study Participants # of FSPs/Days of FSP Cost Offsets by Notes FSP Costs by Age Service by Age Age Group Group County Group  FY 08-09 excluded from analysis; Not in Alpine Statewide Data Collection System Alameda  Not in Statewide Data Collection System Amador    FY 08-09 excluded from analysis Berkeley  Not in Statewide Data Collection System Butte    Calaveras    FY 08-09 excluded from analysis; Colusa    FY 08-09 excluded from analysis; Contra Costa    Del Norte    FY 08-09 excluded from analysis; El Dorado    Fresno    Glenn    Humboldt    FY 08-09 excluded from analysis; Imperial    Inyo    FY 08-09 excluded from analysis; Kern    Kings Lake    Lassen    FY 08-09 excluded from analysis; Los Angeles    Madera    Marin  Not in Statewide Data Collection System Mariposa Mendocino  Merced    Modoc Mono    FY 08-09 excluded from analysis; Monterey Not in Statewide Data Collection System Napa    Nevada Orange    Placer    Plumas Riverside   Not in Statewide Data Collection System 233 Tri City indicated that they were in start-up during the entire study period (FY 08-09 and FY 09-10). Start-up years are not included in the calculations. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 178 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets 233 Study Participants # of FSPs/Days of FSP Cost Offsets by Notes FSP Costs by Age Service by Age Age Group Group County Group Sacramento San Benito    San Bernardino    San Diego    San Francisco    San Joaquin    San Luis Obispo    San Mateo*  Santa Barbara  Not in Statewide Data Collection System Santa Clara    Santa Cruz    Shasta    Sierra    Siskiyou    Solano    Sonoma    Stanislaus    Sutter-Yuba Tehama    FY 08-09 excluded from analysis Trinity    Tulare    Tuolumne    Ventura    Yolo    TOTAL 50 43 42 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 179 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Appendix E Revenue & Expenditure Reports Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 180 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Exhibit E.1 Full Service Partnership Program Worksheet: Revenue and Expenditure Report (Fiscal Year 08-09) http://www.dmh.ca.gov/DMHDocs/docs/notices09/09-22_Enclosure2.xls Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 181 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Revenue and Expenditure Reports Process of Transferring Individual County Excel Files from FY 09-10 into Master Cross-Site File The MHSA (FY: 06/07, 07/08, 08/09) Database was created in the Spring of 2011 in order to conduct analyses for Phase II Deliverable 1. It is an aggregated database containing fiscal data from a total of 59 California counties/municipalities spanning three fiscal year periods, covering 25 program data sets, sourced from 589 distinct file locations, containing a total of 4,498 unique variables, encompassing a grand total of 287,265 distinct data points. Fiscal Year 2006-2007 contained 1,325 distinct variables provided by 57 counties/municipalities across 6 programs located within 57 separate files containing a total of 72,525 distinct data points. Fiscal Year 2007-2008 contained 1,265 distinct variables provided by 59 counties/municipalities across 7 programs located within 60 separate files containing a total of 75,900 distinct data points. Fiscal Year 2008-2009 contained 2,264 distinct variables provided by 59 counties/municipalities across 11 programs located within 472 separate files containing a total of 135,840 distinct data points. The MHSA Database was constructed through a process of template creation, formula crafting, running transfer protocols and performing validity checks. Templates were formed via construction of a list of all variables across each program over all three fiscal years. Formula were generated to transfer the values of individual cells to the database template and were compiled to transfer all the relevant data points within a given workbook and, subsequently, entire source- file. Formulas were crafted for each of the unique variables contained within each program or workbook. Master formulae were crafted for each workbook within a file or fiscal year. The master formulae performed the relocation of each relevant data point, across all programs, within a given file or fiscal year. Transfer protocols were generated to perform manual and semi-automated opening and closing of files, updating formula and transferring the relevant data values of each fiscal year to the database. Validity checks were performed throughout each stage of the process with full checks on each new formula, random spot checks, specific value checks and redundant report checks. Challenges/Limitations Complications in the construction of the database template arose from the systemic variance within a specific program across multiple fiscal years. Each program contains differing sets of reported variables across each fiscal year. Such complexity required the database construction and formulae formats to account for the disparate data formats. This was accomplished through the merger of otherwise identical variables names that were renamed and through the adjustment of cell-specific spacing references in all formulae. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 182 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Further complicating the construction of the database was the systemic variance among the three fiscal years in file sets and data locations. While fiscal years 2006-2007 and 2007-2008 are rather similar the 2008- 2009 fiscal year is provided in an entirely different file set format. Additionally, each fiscal year contains noteworthy variance in data locations from the other fiscal years. This complexity required the substantial retooling of the formula sets and numerous additional, unique formula sets to be constructed. However, the most severe complications came as a result of modifications performed by reporting counties to the file names, workbook names and, most significantly, workbook formats. Variances which caused transfer protocols to report incorrect and invalid data points, if not miss the source-data entirely. These issues necessitated the manual reformatting of all files and workbooks locations found to be employing deviant standards and the subsequent manual operation of all associated transfer protocols. UCLA hired a contractor to complete the initial extraction and merge. The contractor’s services have been retained to complete the extraction and merge for the FY 09-10 data. However, in the interest of expediency, FSP totals were taken from RERs through transcription and input into county Expenditures and Cost Offsets worksheets (provided to counties for review). Totals were cross- checked for accuracy. This initial process was much less costly and time-consuming, and met the immediate deliverable deadline need. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 183 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Exhibit E.5 Counties/Municipalities that submitted Revenue and Expenditure Reports (Fiscal Year 08-09 & Fiscal Year 09-10) Revenue & Expenditure Report Counties FY 08/09 FY 09/10 Alameda 1 1 Alpine 1 1 Amador 1 1 Berkeley City 1 1 Butte 1 1 Calaveras 1 1 Colusa 1 1 Contra Costa 1 1 Del Norte 1 0 El Dorado 1 1 Fresno 1 1 Glenn 1 1 Humboldt 1 1 Imperial 1 1 Inyo 1 1 Kern 1 1 Kings 1 1 Lake 1 1 Lassen 1 1 Los Angeles 1 1 Madera 1 1 Marin 1 1 Mariposa 1 1 Mendocino 1 1 Merced 1 1 Modoc 1 1 Mono 1 1 Monterey 1 1 Napa 1 1 Nevada 1 1 Orange 1 1 Placer 1 1 Plumas 1 1 Riverside 1 1 Sacramento 1 1 Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 184 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Revenue & Expenditure Report Counties FY 08/09 FY 09/10 San Benito 1 1 San Bernardino 1 1 San Diego 1 1 San Francisco 1 1 San Joaquin 1 1 San Luis Obispo 1 1 San Mateo 1 1 Santa Barbara 1 1 Santa Clara 1 1 Santa Cruz 1 1 Shasta 1 1 Sierra 1 1 Siskiyou 1 0 Solano 1 1 Sonoma 1 0 Stanislaus 1 1 Sutter-Yuba 1 1 Tehama 1 1 Tri City 1 1 Trinity 1 1 Tulare 1 1 Tuolumne 1 1* Ventura 1 1 Yolo 1 1 *New summary format Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 185 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Appendix F Key Stakeholder Contacts Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 186 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets LIST OF PRESENTATIONS, MEETINGS, INTERVIEWS, CALLS PERSONALLY CONDUCTED BY DR. HARRIS WITH KEY STAKEHOLDERS IN RE: STATEWIDE MHSA EVALUATION March 22, 2011 In-person with Southern Regional MHSA Coordinators Service Providers March 23, 2011 In-person with Bay Area Regional MHSA Coordinators Service Providers March 29, 2011 In-person with Superior Regional MHSA Coordinators Service Providers March 30, 2011 In-person with Central Regional MHSA Coordinators Service Providers April 1, 2011 In-person with LA County DMH Service Providers April 15, 2011 In-person with FSP Practices Workgroup (Todd Gilmer, UCSD, Service Providers Jen Clancy, CiMH, and others) May 9, 2011 In-person with MHSA Partners Service Providers May 11, 2011 In-person with NAMI CA (Kathleen Derby) Client & Family Agency June 13, 2011 In-person with California Network of Mental Health Clients Client & Family Agency (Delphine Brody and client representatives) June 13, 2011 In-person with California Department of Aging (Lin Benjamin) Agency representing under-served June 13, 2011 In-person with California Community Colleges - Student Service Providers Services and Special Programs (Betsy Sheldon) June 14, 2011 In-person with United Advocates for Children and Families Client & Family Agency (Oscar Wright) June 14, 2011 In-person with Client and Family Leadership Committee (Dee Client & Family Agency Lemonds), Cultural and Linguistic Competence Committee (Pete Best) June 14, 2011 Webinar with NAMI CA clients and family representatives, Client & Family Agency onsite at NAMI CA offices June 23, 2011 In-person with the California Mental Health Directors Service Providers & Agency Association (Heather Anders, contact) and Mental Health and representing under-served Aging Coalition (Vivana Criado) July 15, 2011 In-person at Nevada County (Michele Violett) Presentation to Clients & Families July 22, 2011 In-person at Shasta County (Jaime Hannigan) Presentation to Clients & Families July 22, 2011 Telephone call with Alameda County (Rick Crispino) Service Providers July 22, 2011 In-person with California Mental Health Planning Council (Ann Association Arneill-Py) July 22, 2011 In-person with California Council of Community Mental Health Association Agencies (Harriett Markell) July 22, 2011 In-person with Sacramento Association of Mental Health Association Contractors (John Buck) July 22, 2011 In-person with CASRA (Joseph Robinson) Association Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 187 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Appendix G FSP Expenditures by County Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 188 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.1 Full Service Partnership Services – Children, Youth and Families: Annualized Expenditure per-Client FY 08-09 1 Small Counties are grouped together in the table 2 Children, Youth, and Families Total CYF Number of Daily Expenditures Participants Annualized Expenditure as a % of FSP during Fiscal Number of per-FSP per-FSP Total CYF FSP Total County Year 08-09 Sum of Days Client Years expenditure Client Expenditures Expenditures Butte 3 11 1,369 3.8 -- -- -- -- Contra Costa 112 21,109 57.8 $72,054.99 $197.41 $4,164,778.18 31.6% 4 Fresno 129 31,968 87.6 -- -- -- -- Kern 53 13,033 35.7 $19,269.87 $52.79 $687,934.48 11.5% Los Angeles 2,223 580,545 1,590.5 $17,518.83 $48.00 $27,863,702.00 20.3% Merced 58 8,418 23.1 $3,759.79 $10.30 $86,851.14 3.5% Orange 291 62,721 171.8 $30,043.43 $82.31 $5,161,462.00 22.3% Placer 20 3,135 8.6 $28,300.58 $77.54 $243,385.00 6.3% Riverside 402 118,171 323.8 $16,879.67 $46.25 $5,465,637.00 23.7% San Bernardino 447 70,203 192.3 $41,982.25 $115.02 $8,073,186.00 32.9% San Diego 282 51,520 141.2 $36,367.51 $99.64 $5,135,092.00 23.0% San Francisco 155 34,225 93.8 $9,785.14 $26.81 $917,846.00 13.8% San Joaquin 28 4,417 12.1 $26,113.78 $71.54 $315,976.72 4.3% San Luis Obispo 23 4,522 12.4 $40,456.37 $110.84 $501,659.00 16.2% Santa Clara 65 11,791 32.3 $70,441.64 $192.99 $2,275,265.00 14.22% Santa Cruz * -- -- -- -- -- -- Small Counties 160 29,876 81.9 $20,330.21 $55.70 $1,665,043.87 10.9% Solano 36 9,828 26.9 $14,616.38 $40.04 $393,180.50 14.8% Sonoma 84 24,587 67.4 $6,599.76 $18.08 $444,823.90 15.4% Stanislaus 32 6,495 17.8 $23,376.02 $64.04 $416,093.13 7.1% Tulare 9 1,987 5.4 $17,237.80 $47.23 $93,084.13 9.0% Ventura 78 11,438 31.3 $19,952.97 $54.67 $624,528.00 12.5% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 1 See Appendix D for County Participants 2 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. 3 When displaying by-county results, outliers were excluded from the tables when outlier status was clearly due to procedural or data-related anomalies. 4 When displaying by-county results, outliers were excluded from the tables when outlier status was clearly due to procedural or data-related anomalies. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 189 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.2 Full Service Partnership Services – Children, Youth and Families: Core FSP Expenditures FY 08-09 5 Small Counties are grouped together in the table 6 Core Expenditures County Housing Services Total Alameda $108,784.35 -- $108,784.35 Butte 7 -- -- -- Contra Costa $1,450,476.18 $2,714,302.00 $4,164,778.18 Fresno 8 -- -- -- Kern -- $687,934.48 $687,934.48 Los Angeles -- $27,863,702.00 $27,863,702.00 Marin -- $467,878.00 $467,878.00 Merced -- $86,851.14 $86,851.14 Orange $840,854.79 $4,320,607.21 $5,161,462.00 Placer -- $243,385.00 $243,385.00 Riverside $36,354.24 $5,429,282.76 $5,465,637.00 San Bernardino -- $8,073,186.00 $8,073,186.00 San Diego -- $5,135,092.00 $5,135,092.00 San Francisco -- $917,846.00 $917,846.00 San Joaquin -- $315,976.72 $315,976.72 San Luis Obispo -- $501,659.00 $501,659.00 San Mateo -- $1,563,623.00 $1,563,623.00 Santa Barbara -- $565,442.00 $565,442.00 Santa Clara $22,940.65 $2,252,324.35 $2,275,265.00 Santa Cruz* -- -- -- Small Counties $20,769.82 $1,996,441.80 $2,017,211.62 Solano -- $393,180.50 $393,180.50 Sonoma -- $444,823.90 $444,823.90 Stanislaus $19,981.95 $396,111.18 $416,093.13 Tulare $7,250.90 $85,833.23 $93,084.13 Ventura $238,000.00 $386,528.00 $624,528.00 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 5 See Appendix D for County Participants 6 Small counties included for purpose of FY 08-09 analyses = Alpine, Berkeley, El Dorado, Glenn, Imperial, Lake, Madera, Mendocino, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. 7 When displaying by-county results, outliers were excluded from the tables when outlier status was clearly due to procedural or data-related anomalies. 8 Ibid. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 190 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.3 Full Service Partnership Services – Children, Youth and Families: Annualized Expenditure per-Client FY 09-10 9 Small Counties are grouped together in the table 10 Children, Youth, and Families Total CYF Number of Daily Expenditures Participants Annualized Expenditure as a % of FSP during Fiscal Number of per-FSP Total CYF FSP per-FSP Total County Year 09-10 Sum of Days Client Years Expenditure Expenditures Expenditures Client 11 Butte 5 780 2.1 -- -- -- -- Contra Costa 133 30,762 84.3 $39,072.59 $3,293,819.24 $107.05 34.3% 12 Fresno 253 46,516 127.4 -- -- -- -- Kern 53 13,317 36.5 $18,644.84 $680,536.56 $51.08 9.4% Los Angeles 3,165 820,496 2,247.9 $18,095.06 $40,675,886.00 $49.58 22.1% Merced 71 16,329 44.7 $12,431.35 $555,681.52 $34.06 23.8% Orange 278 94,798 259.7 $20,111.29 $5,222,903.00 $55.10 21.0% Placer 13 2,841 7.8 $20,142.82 $157,114.00 $55.19 6.7% Riverside 209 50,999 139.7 $32,547.75 $4,546,920.00 $89.17 23.3% San Bernardino 671 109,552 300.1 $26,571.40 $7,974,077.00 $72.80 30.3% San Diego 768 105,839 290.0 $5,745.29 $1,666,134.00 $15.74 7.2% San Francisco 196 40,393 110.7 $9,369.71 $1,037,227.00 $25.67 11.7% San Joaquin 59 6,552 18.0 $18,891.00 $340,038.08 $51.76 4.9% San Luis Obispo 75 14,553 39.9 $17,486.39 $697,707.00 $47.91 19.0% Santa Clara 88 17,722 48.6 $54,663.66 $2,656,654.00 $149.76 14.74% Santa Cruz* -- -- -- -- -- -- -- Small Counties 281 63,726 174.6 $12,918.83 $2,255,628.57 $35.39 8.8% Solano 45 9,732 26.7 $14,666.67 $391,600.00 $40.18 11.7% Sonoma 116 36,099 98.9 $3,933.95 $389,067.65 $10.78 11.5% Stanislaus 30 6,480 17.8 $23,598.50 $420,053.26 $64.65 7.5% Tulare 10 2,657 7.3 $11,320.81 $82,641.89 $31.02 8.3% Ventura 38 5,187 14.2 $45,600.42 $647,526.00 $124.93 6.4% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 9 See Appendix D for County Participants 10 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Lake, Lassen, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditures per person and cost offset analyses could not be conducted. Humboldt, Inyo, Mono and Tehama counties did not provide FSP services in FY 08-09/FY 09-10 to CYF, nor claim expenditures for CYF in the study, and are therefore not included in the Small County pool. 11 When displaying by-county results, outliers were excluded from the tables when outlier status was clearly due to procedural or data-related anomalies. 12 Ibid. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 191 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.4 Full Service Partnership Services – Children, Youth and Families: Percent of Core FSP Expenditures FY 09-10 13 Small Counties are grouped together in the table 14 Core Expenditures County Housing Services Total Alameda $39,768.13 -- $39,768.13 Butte 15 -- -- -- Contra Costa $852,781.44 $2,441,037.80 $3,293,819.24 Fresno 16 -- -- -- Kern -- $680,536.56 $680,536.56 Los Angeles -- $40,675,886.00 $40,675,886.00 Marin -- $461,144.00 $461,144.00 Merced -- $555,681.52 $555,681.52 Orange $752,612.70 $4,470,290.30 $5,222,903.00 Placer -- $157,114.00 $157,114.00 Riverside $13,047.33 $4,533,872.67 $4,546,920.00 San Bernardino -- $7,974,077.00 $7,974,077.00 San Diego -- $1,666,134.00 $1,666,134.00 San Francisco -- $1,037,227.00 $1,037,227.00 San Joaquin -- $340,038.08 $340,038.08 San Luis Obispo -- $697,707.00 $697,707.00 San Mateo -- $1,926,746.50 $1,926,746.50 Santa Barbara -- $617,758.00 $617,758.00 Santa Clara $25,116.54 $2,631,537.46 $2,656,654.00 Santa Cruz* -- -- -- Small Counties $24,291.72 $2,338,911.85 $2,363,203.57 Solano -- $391,600.00 $391,600.00 Sonoma -- $389,067.65 $389,067.65 Stanislaus $18,897.92 $401,155.34 $420,053.26 Tulare $1,844.67 $80,797.22 $82,641.89 Ventura $10,800.00 $636,726.00 $647,526.00 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 13 See Appendix D for County Participants 14 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Lake, Lassen, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Humboldt, Inyo, Mono and Tehama counties did not provide FSP services in FY 08-09/FY 09-10 to CYF, nor claim expenditures for CYF in the study, and are therefore not included in the Small County pool. 15 When displaying by-county results, outliers were excluded from the tables when outlier status was clearly due to procedural or data-related anomalies. 16 Ibid. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 192 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.5 Full Service Partnership Services – Transition Age Youth: Annualized Expenditure per-Client FY 08-09 17 Small Counties are grouped together in the table 18 Transition Age Youth Total TAY Number of Daily Expenditures Participants Annualized Expenditure as a % of FSP during Fiscal Number of per-FSP per-FSP Total TAY FSP Total County Year 08-09 Sum of Days Client Years Expenditure Expenditures Expenditures Client Butte 44 7,600 20.8 $37,108.09 $101.67 $771,848.20 51.9% Contra Costa 98 25,038 68.6 $26,393.34 $72.31 $1,810,583.08 13.7% Fresno 19 155 41,213 112.9 -- -- -- -- Kern 182 35,619 97.6 $17,013.87 $46.61 $1,660,553.87 27.7% Los Angeles 1,257 333,383 913.4 $23,756.24 $65.09 $21,698,945.60 15.8% Merced 34 7,706 21.1 $92,470.00 $253.34 $1,951,116.95 78.9% Orange 598 156,383 428.4 $12,388.70 $33.94 $5,307,317.00 23.0% Placer 20 33 8,927 24.5 -- -- -- -- Riverside 212 142,269 389.8 $8,694.66 $23.82 $3,389,178.00 14.7% San Bernardino 682 129,544 354.9 $12,023.69 $32.94 $4,267,208.00 17.4% San Diego 401 82,746 226.7 $16,043.92 $43.96 $3,637,156.00 16.3% San Francisco 145 33,154 90.8 $10,602.17 $29.05 $962,677.00 14.5% San Joaquin 122 20,373 55.8 $14,332.31 $39.27 $799,742.99 10.8% San Luis Obispo 30 6,378 17.5 $35,652.46 $97.68 $623,918.00 20.2% Santa Clara 131 28,241 77.4 $25,735.85 $70.51 $1,991,955.00 12.45% Santa Cruz 63 17,821 48.8 $24,898.80 $68.22 $1,215,061.30 38.8% Small Counties 261 51,874 142.1 $20,302.33 $55.62 $2,884,961.16 18.9% Solano 25 6,517 17.9 $64,244.55 $176.01 $1,149,977.50 43.1% Sonoma 58 18,519 50.7 $21,871.01 $59.92 $1,108,860.40 38.4% Stanislaus 105 19,059 52.2 $6,753.44 $18.50 $352,529.77 6.0% Tulare 65 14,061 38.5 $12,286.53 $33.66 $473,031.59 45.6% Ventura 104 19,859 54.4 $26,088.46 $71.48 $1,419,212.00 28.4% 17 See Appendix D for County Participants 18 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. 19 There were no FSP expenditures for Fresno TAY reported on their web survey, but there were TAY in the DCR database. 20 There were no FSP expenditures for Placer TAY reported on their web survey, but there were TAY in the DCR database. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 193 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.6 Full Service Partnership Services – Transition Age Youth: Core FSP Expenditures FY 08-09 21 Small Counties are grouped together in the table 22 Core FSP Expenditures County Housing Services Total Alameda $478,651.14 $2,087,727.00 $2,566,378.14 Butte $148,440.40 $623,407.80 $771,848.20 Contra Costa $644,656.08 $1,165,927.00 $4,164,778.18 Fresno 23 -- -- -- Kern $43,550.43 $1,617,003.44 $1,660,553.87 Los Angeles $623,122.60 $21,075,823.00 $21,698,945.60 Marin $33,119.52 $354,864.48 $387,984.00 Merced $24,200.00 $1,926,916.95 $1,951,116.95 Orange $942,645.48 $4,364,671.52 $5,307,317.00 Placer 24 -- -- -- Riverside $230,243.52 $3,158,934.48 $3,389,178.00 San Bernardino -- $4,267,208.00 $4,267,208.00 San Diego $427,971.90 $3,209,184.10 $3,637,156.00 San Francisco $165,331.28 $797,345.72 $962,677.00 San Joaquin -- $799,742.99 $799,742.99 San Luis Obispo $24,074.83 $599,843.17 $623,918.00 San Mateo $218,691.00 $1,344,932.00 $1,563,623.00 Santa Barbara $210,425.00 $261,419.00 $471,844.00 Santa Clara $45,881.30 $1,946,073.70 $1,991,955.00 Santa Cruz $23,744.40 $1,191,316.90 $1,215,061.30 Small Counties $49,960.41 $3,382,010.70 $3,431,971.11 Solano -- $1,149,977.50 $1,149,977.50 Sonoma $153,000.00 $955,860.40 $1,108,860.40 Stanislaus $38,572.56 $313,957.21 $352,529.77 Tulare $65,258.10 $407,773.49 $473,031.59 Ventura $646.00 $1,418,566.00 $1,419,212.00 21 See Appendix D for County Participants 22 Small counties included for purpose of FY 08-09 analyses = Alpine, Berkeley, El Dorado, Glenn, Imperial, Lake, Madera, Mendocino, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. 23 There were no FSP expenditures for Fresno TAY reported on their web survey, but there were TAY in the DCR database. 24 There were no FSP expenditures for Placer TAY reported on their web survey, but there were TAY in the DCR database. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 194 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.7 Full Service Partnership Services – Transition Age Youth: Annualized Expenditure per-Client FY 09-10 25 Small Counties are grouped together in the table 26 Transition Age Youth Total TAY Number of Daily Expenditures Participants Annualized Expenditure as a % of FSP during Fiscal Number of per-FSP per-FSP Total TAY FSP Total County Year 09-10 Sum of Days Client Years Expenditure Expenditures Expenditures Client Butte 45 9,692 26.6 $26,814.78 $73.47 $713,273.18 34.4% Contra Costa 134 33,834 92.7 $14,511.83 $39.76 $1,345,246.38 14.0% Fresno 27 241 60,943 167.0 -- -- -- -- Kern 207 39,400 107.9 $20,752.64 $56.86 $2,239,210.15 30.8% Los Angeles 1,702 477,643 1,308.6 $17,464.38 $47.85 $22,853,881.40 12.4% Merced 45 10,994 30.1 $43,038.99 $117.92 $1,295,473.69 55.5% Orange 677 229,267 628.1 $7,555.63 $20.70 $4,745,692.00 19.1% Placer 28 30 9,293 25.5 -- -- -- -- Riverside 284 190,587 522.2 $5,777.09 $15.83 $3,016,794.00 15.4% San Bernardino 1,015 208,031 569.9 $9,650.56 $26.44 $5,499,852.40 20.9% San Diego 657 126,303 346.0 $13,681.38 $37.48 $4,733,759.14 20.5% San Francisco 184 40,172 110.1 $11,478.83 $31.45 $1,263,819.00 14.2% San Joaquin 224 49,117 134.6 $6,021.59 $16.50 $810,506.12 11.8% San Luis Obispo 59 11,435 31.3 $20,210.64 $55.37 $632,593.16 17.3% Santa Clara 178 36,908 101.1 $23,978.08 $65.69 $2,424,184.00 13.45% Santa Cruz 36 11,916 32.6 $46,598.05 $127.67 $1,519,096.30 39.0% Small Counties 452 102,834 281.7 $17,965.30 $49.22 $5,060,825.00 19.8% Solano 36 8,444 23.1 $54,570.82 $129.51 $1,260,586.00 37.8% Sonoma 85 24,555 67.3 $15,331.40 $42.00 $1,031,803.50 30.4% Stanislaus 106 18,786 51.5 $5,584.11 $15.30 $287,581.77 5.1% Tulare 100 20,225 55.4 $9,119.39 $24.98 $505,213.93 50.8% Ventura 410 90,024 246.6 $11,193.74 $30.67 $2,760,377.00 27.2% 25 See Appendix D for County Participants 26 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. 27 There were no FSP expenditures for Fresno TAY reported on their web survey, but there were TAY in the DCR database. 28 There were no FSP expenditures for Placer TAY reported on their web survey, but there were TAY in the DCR database. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 195 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.8 Full Service Partnership Services – Transition Age Youth: Core FSP Expenditures FY 09-10 29 Small Counties are grouped together in the table 30 Core FSP Expenditures Housing Services Total County Alameda $715,826.34 $1,841,902.00 $2,557,728.34 Butte $59,755.98 $653,517.20 $713,273.18 Contra Costa $335,021.28 $1,010,225.10 $1,345,246.38 Fresno 31 -- -- -- Kern $54,642.96 $2,184,567.19 $2,239,210.15 Los Angeles $296,955.40 $22,556,926.00 $22,853,881.40 Marin $31,043.88 $353,369.12 $384,413.00 Merced $19,580.00 $1,275,893.69 $1,295,473.69 Orange $858,216.70 $3,887,475.30 $4,745,692.00 Placer 32 -- -- -- Riverside $1,239,496.35 $1,777,297.65 $3,016,794.00 San Bernardino $506,140.40 $4,993,712.00 $5,499,852.40 San Diego $659,996.04 $4,073,763.10 $4,733,759.14 San Francisco $129,245.32 $1,134,573.68 $1,263,819.00 San Joaquin -- $810,506.12 $810,506.12 San Luis Obispo $12,550.16 $620,043.00 $632,593.16 San Mateo $204,832.00 $1,721,914.50 $1,926,746.50 Santa Barbara $335,206.00 $479,892.00 $815,098.00 Santa Clara $41,860.90 $2,382,323.10 $2,424,184.00 Santa Cruz $58,769.20 $1,460,327.10 $1,519,096.30 Small Counties $803,766.51 $4,930,999.49 $5,734,766.00 Solano -- $1,260,586.00 $1,260,586.00 Sonoma $153,000.00 $878,803.50 $1,031,803.50 Stanislaus $25,801.78 $261,779.99 $287,581.77 Tulare $92,331.02 $412,882.91 $505,213.93 Ventura $81,000.00 $2,679,377.00 $2,760,377.00 29 See Appendix D for County Participants 30 Small counties included for purpose of FY 09-10 analyses = Alpine, Amador, Berkeley, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mendocino, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. 31 There were no FSP expenditures for Fresno TAY reported on their web survey, but there were TAY in the DCR database. 32 There were no FSP expenditures for Placer TAY reported on their web survey, but there were TAY in the DCR database. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 196 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.9 Full Service Partnership Services – Adults: Annualized Expenditure per-Client FY 08-09 33 Small Counties are grouped together in the table 34 Adults Adult Number of Daily Expenditures Participants Annualized Expenditure as a % of FSP during Fiscal Number of per-FSP per-FSP Total Adult FSP Total County Year 08-09 Sum of Days Client Years Expenditure Expenditures Expenditures Client Butte 79 20,676 56.6 $12,625.70 $34.59 $714,614.54 48.0% Contra Costa 160 43,794 120.0 $60,104.57 $134.67 $7,212,547.98 54.7% Fresno 330 68,034 186.4 $38,502.95 $105.49 $7,176,950.00 99.8% Kern 345 76,068 208.4 $12,968.81 $35.53 $2,702,699.08 45.1% Los Angeles 4,176 1,148,521 3,146.6 $26,043.17 $71.35 $81,947,433.40 59.7% Merced 37 9,146 25.1 $10,665.34 $29.22 $267,699.91 10.8% Orange 680 179,676 492.3 $20,683.71 $56.67 $10,182,588.00 44.1% Placer 75 20,430 56.0 $64,318.98 $176.22 $3,601,863.00 93.7% Riverside 580 135,021 369.9 $31,109.74 $85.23 $11,507,491.00 49.9% San Bernardino 705 112,206 307.4 $38,543.90 $105.60 $11,848,393.61 48.2% San Diego 658 192,267 526.8 $22,352.06 $61.24 $11,775,066.00 52.7% San Francisco 267 51,522 141.2 $28,430.48 $77.89 $4,014,384.00 60.5% San Joaquin 485 93,546 256.3 $20,215.86 $55.39 $5,181,324.34 70.1% San Luis Obispo 58 12,114 33.2 $47,271.51 $129.51 $1,569,414.00 50.8% Santa Clara 341 85,228 233.5 $46,776.27 $128.15 $10,922,259.00 68.3% Santa Cruz 41 13,321 36.5 $20,207.18 $55.36 $737,562.25 23.6% Small Counties 493 107,065 293.3 30,112.35 $82.50 $8,831,952.15 57.9% Solano 38 9,000 24.7 $10,297.09 $28.21 $254,338.00 9.5% Sonoma 179 61,259 167.8 $7,166.72 $19.63 $1,202,576.40 41.7% Stanislaus 300 68,507 187.7 $22,442.57 $61.49 $4,212,470.36 72.1% Tulare 125 21,733 59.5 $6,815.18 $18.67 $405,503.28 39.1% Ventura 68 9,909 27.1 $49,462.25 $135.51 $1,340,427.00 26.8% 33 See Appendix D for County Participants 34 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 197 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.10 Full Service Partnership Services – Adults: Core FSP Expenditures FY 08-09 35 Small Counties are grouped together in the table 36 Core FSP Expenditures County Housing Services Total Alameda $1,196,627.85 $4,969,600.00 $6,166,227.85 Butte $188,996.00 $525,618.54 $714,614.54 Contra Costa $2,524,902.98 $4,687,645.00 $7,212,547.98 Fresno $7,128,072.00 $48,878.00 $7,176,950.00 Kern $199,819.62 $2,502,879.46 $2,702,699.08 Los Angeles $2,583,057.40 $79,364,376.00 $81,947,433.40 Marin $518,872.48 $985,302.52 $1,504,175.00 Merced $28,600.00 $239,099.91 $267,699.91 Orange $1,214,568.03 $8,968,019.97 $10,182,588.00 Placer -- $3,601,863.00 $3,601,863.00 Riverside $896,737.92 $10,610,753.08 $11,507,491.00 San Bernardino $2,500,976.61 $9,347,417.00 $11,848,393.61 San Diego $2,054,265.12 $9,720,800.88 $11,775,066.00 San Francisco $281,057.30 $3,733,326.70 $4,014,384.00 San Joaquin -- $5,181,324.34 $5,181,324.34 San Luis Obispo $161,116.17 $1,408,297.83 $1,569,414.00 San Mateo $387,679.50 $1,388,961.50 $1,776,641.00 Santa Barbara $390,988.00 $2,839,395.00 $3,230,383.00 Santa Clara $321,169.10 $10,601,089.90 $10,922,259.00 Santa Cruz $23,744.40 $713,817.85 $737,562.25 Small Counties $316,158.71 $9,478,300.89 $9,794,459.60 Solano $129,921.06 $124,416.94 $254,338.00 Sonoma $51,000.00 $1,151,576.40 $1,202,576.40 Stanislaus $358,009.89 $3,854,460.47 $4,212,470.36 Tulare $69,608.64 $335,894.64 $405,503.28 Ventura $2,380.00 $1,338,047.00 $1,340,427.00 35 See Appendix D for County Participants 36 Small counties included for purpose of FY 08-09 analyses = Alpine, Berkeley, El Dorado, Glenn, Imperial, Lake, Madera, Mendocino, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 198 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.11 Full Service Partnership Services – Adults: Annualized Expenditure per-Client FY 09-10 37 Small Counties are grouped together in the table 38 Adults Adult Number of Daily Expenditures Participants Annualized Expenditure Total Adult as a % of FSP during Fiscal Number of per-FSP per-FSP FSP Total County Year 09-10 Sum of Days Client Years Expenditure Expenditures Expenditures Client Butte 143 37,156 101.8 $13,177.70 $18.58 $1,341,490.14 64.8% Contra Costa 188 59,159 162.1 $30,542.55 $107.05 $4,950,947.36 51.6% Fresno 369 99,210 271.8 $24,516.24 $67.17 $6,663,514.00 99.7% Kern 317 69,998 191.8 $17,805.96 $48.78 $3,415,182.33 47.0% Los Angeles 4,541 1,357,732 3,719.8 $30,583.96 $83.79 $113,766,228.00 61.9% Merced 39 11,090 30.4 $10,542.49 $28.88 $320,491.79 13.7% Orange 724 226,632 620.9 $19,766.27 $54.15 $12,272,875.00 49.4% Placer 77 23,466 64.3 $33,924.37 $92.94 $2,181,337.00 93.3% Riverside 626 145,729 399.3 $24,028.32 $65.83 $9,594,507.00 49.1% San Bernardino 983 260,608 714.0 $17,102.30 $46.86 $12,211,045.52 46.5% San Diego 1,242 264,709 725.2 $20,132.81 $55.16 $14,600,315.00 63.3% San Francisco 284 84,724 232.1 $24,404.64 $66.86 $5,664,316.00 63.8% San Joaquin 937 236,492 647.9 $7,409.88 $20.30 $4,800,862.88 69.8% San Luis Obispo 64 13,564 37.2 $55,558.11 $152.21 $2,066,761.84 56.4% Santa Clara 416 102,633 281.2 $43,797.53 $119.99 $12,315,865.00 68.3% Santa Cruz 36 3,630 9.9 $95,413.41 $261.41 $944,592.75 24.3% Small Counties 915 206,213 565.0 27,171.81 $74.44 $15,352,070.86 60.0% Solano 82 22,387 61.3 $8,125.87 $22.26 $498,116.00 14.9% Sonoma 204 70,115 192.1 $6,028.10 $16.52 $1,157,998.70 34.1% Stanislaus 263 65,635 179.8 $22,615.28 $61.96 $4,066,228.06 72.2% Tulare 143 26,217 71.8 $5,066.28 $13.88 $363,759.22 36.6% Ventura 766 215,037 589.1 $8,107.26 $36.98 $4,775,989.00 47.0% 37 See Appendix D for County Participants 38 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 199 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.12 Full Service Partnership Services – Adults: Core FSP Expenditures FY 09-10 39 Small Counties are grouped together in the table 40 Core FSP Expenditures Housing Services Total County Alameda $2,465,624.06 $7,192,694.00 $9,658,318.06 Butte $207,079.02 $1,134,411.12 $1,341,490.14 Contra Costa $1,279,172.16 $3,671,775.20 $4,950,947.36 Fresno $5,950,632.00 $712,882.00 $6,663,514.00 Kern $163,928.88 $3,251,253.45 $3,415,182.33 Los Angeles $2,514,712.60 $111,251,515.40 $113,766,228.00 Marin $481,180.14 $1,179,137.86 $1,660,318.00 Merced $23,140.00 $297,351.79 $320,491.79 Orange $3,160,973.34 $9,111,901.66 $12,272,875.00 Placer -- $2,181,337.00 $2,181,337.00 Riverside $39,141.99 $9,555,365.01 $9,594,507.00 San Bernardino $4,454,035.52 $7,757,010.00 $12,211,045.52 San Diego $2,008,683.60 $12,591,631.40 $14,600,315.00 San Francisco $298,159.48 5,366,156.52 $5,664,316.00 San Joaquin -- $4,800,862.88 $4,800,862.88 San Luis Obispo $144,326.84 $1,922,435.00 $2,066,761.84 San Mateo $537,684.00 $1,730,916.00 $2,268,600.00 Santa Barbara $815,321.00 $4,396,167.00 $5,211,488.00 Santa Clara $694,890.94 $11,620,974.06 $12,315,865.00 Santa Cruz $58,769.20 $885,823.55 $944,592.75 Small Counties $995,593.67 $14,846,800.19 $15,842,393.86 Solano $135,002.80 $363,113.20 $498,116.00 Sonoma $51,000.00 $1,106,998.70 $1,157,998.70 Stanislaus $368,494.50 $3,697,733.56 $4,066,228.06 Tulare $39,343.56 $324,415.66 $363,759.22 Ventura $151,200.00 $4,624,789.00 $4,775,989.00 39 See Appendix D for County Participants 40 Small counties included for purpose of FY 09-10 analyses = Alpine, Amador, Berkeley, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mendocino, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 200 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.13 Full Service Partnership Services – Older Adults: Annualized Expenditure per-Client FY 08-09 41 Small Counties are grouped together in the table 42 Older Adults Older Adult Number of Daily Expenditures Participants Annualized Expenditure Total Older as a % of FSP during Fiscal Number of per-FSP per-FSP Adult FSP Total County Year 08-09 Sum of Days Client Years Expenditure Expenditures Expenditures Client 43 Butte 3 441 1.2 -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno 44 10 1,726 4.7 -- -- -- -- Kern 79 22,850 62.6 $14,987.47 $41.06 $938,215.57 15.7% Los Angeles 373 98,535 270.0 $21,186.65 $58.05 $5,720,395.00 4.2% Merced 1 7 0.0 -- -- $167,760.00 6.8% Orange 125 34,172 93.6 $26,157.85 $71.67 $2,448,375.00 10.6% 45 Placer 23 6,291 17.2 -- -- -- -- Riverside 203 67,729 185.6 $14,593.75 $39.98 $2,708,600.00 11.7% San Bernardino 34 8,180 22.4 $17,060.60 $46.74 $382,157.39 1.6% San Diego 157 37,585 103.0 $17,338.78 $47.50 $1,785,894.00 8.0% San Francisco 67 15,768 43.2 $17,263.22 $47.30 $745,771.00 11.2% San Joaquin 99 14,699 40.3 $27,262.95 $74.69 $1,098,696.95 14.9% San Luis Obispo 8 1,260 3.5 $112,063.43 $307.02 $392,222.00 12.7% Santa Clara 28 6,591 18.1 $44,574.97 $122.12 $806,807.00 5.0% Santa Cruz 41 12,864 35.2 $33,492.00 $91.76 $1,178,918.45 37.6% Small Counties 104 21,922 60.1 $31,173.21 $85.41 $1,873,509.82 12.3% Solano 34 8,847 24.2 $35,873.31 $98.28 $868,134.00 32.6% Sonoma 6 2,016 5.5 $23,647.99 $64.79 $130,063.94 4.5% Stanislaus 46 13,574 37.2 $23,100.93 $63.29 $859,354.74 14.7% Tulare 5 1,300 3.6 $18,048.89 $49.45 $64,976.01 6.3% Ventura 145 36,351 99.6 $16,237.96 $44.49 $1,617,301.00 32.3% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 41 See Appendix D for County Participants 42 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra County did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claimed expenditures for Older Adults in the study, and is therefore not included in the Small County pool. 43 When displaying by-county results, outliers were excluded from the tables when outlier status was clearly due to procedural or data-related anomalies. 44 There were no FSP expenditures for Fresno Older Adults reported on their web survey, but there were Older Adult clients in the DCR database. 45 There were no FSP expenditures for Placer Older Adults reported on their web survey, but there were Older Adult clients in the DCR database. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 201 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.14 Full Service Partnership Services – Older Adults: Core FSP Expenditures FY 08-09 46 Small Counties are grouped together in the table 47 Core FSP Expenditures County Housing Services Total Alameda $391,623.66 $1,010,751.00 $1,402,374.66 Butte 48 -- -- -- Contra Costa* -- -- -- Fresno 49 -- -- -- Kern $12,808.95 $925,406.62 $938,215.57 Los Angeles -- $5,720,395.00 $5,720,395.00 Marin -- $423,450.00 $423,450.00 Merced $2,200.00 $165,560.00 $167,760.00 Orange $311,427.70 $2,136,947.30 $2,448,375.00 Placer -- -- -- Riverside $48,472.32 $2,660,127.68 $2,708,600.00 San Bernardino $25,262.39 $356,895.00 $382,157.39 San Diego $370,908.98 $1,414,985.02 $1,785,894.00 San Francisco $73,645.42 $672,125.58 $745,771.00 San Joaquin -- $1,098,696.95 $1,098,696.95 San Luis Obispo -- $392,222.00 $392,222.00 San Mateo $387,679.50 $1,043,446.50 $1,431,126.00 Santa Barbara $16,350.00 $770,279.00 $786,629.00 Santa Clara $68,821.95 $737,985.05 $806,807.00 Santa Cruz $11,872.20 $1,167,046.25 $1,178,918.45 Small Counties $53,682.06 $2,192,791.61 $2,246,473.67 Solano $21,149.94 $846,984.06 $868,134.00 Sonoma -- $130,063.94 $130,063.94 Stanislaus $65,592.60 $793,762.14 $859,354.74 Tulare $2,900.36 $62,075.65 $64,976.01 Ventura $374.00 $1,616,927.00 $1,617,301.00 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 46 See Appendix D for County Participants 47 Small counties included for purpose of FY 08-09 analyses = Alpine, Berkeley, El Dorado, Glenn, Imperial, Lake, Madera, Mendocino, Napa, San Benito, Shasta, Siskiyou, Trinity, Tuolumne, and Yolo. Sierra County did not provide FSP services in FY 08-09/FY09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and is therefore not included in the Small County pool. 48 When displaying by-county results, outliers were excluded from the tables when outlier status was clearly due to procedural or data-related anomalies. 49 There were no FSP expenditures for Fresno Older Adults reported on their web survey, but there were Older Adult clients in the DCR database. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 202 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.15 Full Service Partnership Services – Older Adults: Annualized Expenditure per-Client FY 09-10 50 Small Counties are grouped together in the table 51 Older Adults Older Adult Number of Daily Expenditures Participants Annualized Expenditure Total Older as a % of FSP during Fiscal Number of per-FSP per-FSP Adult FSP Total County Year 09-10 Sum of Days Client Years Expenditure Expenditures Expenditures Client 52 Butte 31 5,461 15.0 -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno 53 11 2,066 5.7 -- -- -- -- Kern 78 19,373 53.1 $17,525.10 $48.01 $930,582.96 12.8% Los Angeles 406 124,749 341.8 $18,759.55 $51.40 $6,412,015.00 3.5% Merced 54 1 365 1.0 -- -- -- -- Orange 142 45,028 123.4 $21,087.65 $57.77 $2,602,216.00 10.5% Placer 55 25 7,796 21.4 -- -- -- -- Riverside 233 77,738 213.0 $11,220.24 $30.74 $2,389,911.00 12.2% San Bernardino 51 13,105 35.9 $16,611.93 $45.51 $596,368.12 2.3% San Diego 225 50,077 137.2 $14,960.49 $40.99 $2,052,578.86 8.9% San Francisco 68 20,954 57.4 $15,896.97 $43.55 $912,486.00 10.3% San Joaquin 152 35,357 96.9 $9,538.23 $26.13 $924,254.92 13.4% San Luis Obispo 15 3,168 8.7 $30,985.52 $84.89 $269,574.00 7.4% Santa Clara 29 8,469 23.2 $26,878.06 $73.64 $623,571.00 3.46% Santa Cruz 30 10,058 27.6 $51,824.74 $141.99 $1,430,362.95 36.7% Small Counties 171 37,070 101.6 $28,848.79 $79.04 $2,931,036.86 11.4% Solano 33 9,524 26.1 $45,505.90 $124.67 $1,187,704.00 35.6% Sonoma 56 20,101 55.1 $14,826.38 $40.62 $816,933.48 24.1% Stanislaus 43 13,516 37.0 $23,154.48 $63.44 $856,715.91 15.2% Tulare 7 904 2.5 $17,421.28 $47.73 $43,553.21 4.4% Ventura 190 53,242 145.9 $13,498.21 $36.98 $1,969,389.00 19.4% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 50 See Appendix D for County Participants 51 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Napa, San Benito, Shasta, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra, Colusa, Del Norte, and Mono counties did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and are therefore not included in the Small County pool. 52 When displaying by-county results, outliers were excluded from the tables when outlier status was clearly due to procedural or data-related anomalies. 53 There were no FSP expenditures for Fresno Older Adults reported on their web survey, but there were Older Adult clients in the DCR database. 54 When displaying by-county results, outliers were excluded from the tables when outlier status was clearly due to procedural or data-related anomalies. 55 There were no FSP expenditures for Placer Older Adults reported on their web survey, but there were Older Adult clients in the DCR database. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 203 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table G.16 Full Service Partnership Services – Older Adults: Core FSP Expenditures FY 09-10 56 Small Counties are grouped together in the table 57 Core FSP Expenditures County Housing Services Total Alameda $755,594.47 $1,101,112.00 $1,856,706.47 Butte 58 -- -- -- Contra Costa* -- -- -- Fresno 59 -- -- -- Kern $9,107.16 $921,475.80 $930,582.96 Los Angeles $6,412,015.00 $6,412,015.00 Marin $5,173.98 $437,255.02 $442,429.00 Merced $1,780.00 $160,326.00 $162,106.00 Orange $351,219.26 $2,250,996.74 $2,602,216.00 Placer 60 -- -- -- Riverside $13,047.33 $2,376,863.67 $2,389,911.00 San Bernardino $151,842.12 $444,526.00 $596,368.12 San Diego $200,868.36 $1,851,710.50 $2,052,578.86 San Francisco $58,641.20 $853,844.80 $912,486.00 San Joaquin -- $924,254.92 $924,254.92 San Luis Obispo $269,574.00 $269,574.00 San Mateo $537,684.00 $741,673.00 $1,279,357.00 Santa Barbara $91,141.00 $911,841.00 $1,002,982.00 Santa Clara $75,349.62 $548,221.38 $623,571.00 Santa Cruz $29,384.60 $1,400,978.35 $1,430,362.95 Small Counties $376,593.76 $2,723,884.10 $3,100,477.86 Solano $21,977.20 $1,165,726.80 $1,187,704.00 Sonoma -- $816,933.48 $816,933.48 Stanislaus $90,387.80 $766,328.11 $856,715.91 Tulare -- $43,553.21 $43,553.21 Ventura $27,000.00 $1,942,389.00 $1,969,389.00 *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 56 See Appendix D for County Participants 57 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Napa, San Benito, Shasta, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra, Colusa, Del Norte, and Mono counties did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim costs for Older Adults in the study, and are therefore not included in the Small County pool. 58 When displaying by-county results, outliers were excluded from the tables when outlier status was clearly due to procedural or data-related anomalies. 59 There were no FSP expenditures for Fresno Older Adults reported on their web survey, but there were Older Adult clients in the DCR database. 60 There were no FSP expenditures for Placer Older Adults reported on their web survey, but there were Older Adult clients in the DCR database. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 204 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Appendix H FSP Cost Offsets by County Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 205 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.1 Full Service Partnership Services – Children, Youth and Families: Expenditures and Cost Offsets FY 08-09 New Enrollees Only 61 Small Counties are grouped together in the table 62 Children, Youth and Families Number of Total FY 08-09 New Enrollees FSP New during Fiscal Enrollee Total Cost Percent of Year 08-09 Sum of Days Expenditure Offset Costs Offset Butte 63 8 951 --- -- -- Contra Costa 76 10,578 $2,088,202.98 $9,129.23 0.4% 64 Fresno 43 4,393 -- -- -- Kern 17 3,230 $170,511.70 ($13,402..08) -7.9% Los Angeles 985 171,448 $8,229,504.00 $1,545,830.35 18.8% Merced 36 3,906 $40,231.80 ($18,652.38) -46.2% Orange 150 26,159 $2,153,147.29 $472,153.04 21.9% Placer 9 1,344 $104,213.76 $75,749.30 72.7% San Bernardino 329 40,076 $4,609,541.52 $367,507.00 8.0% San Diego 140 19,182 $1,911,294.48 ($124,992.53) -6.5% San Francisco 89 15,964 $427,994.84 $54,400.09 12.7% San Joaquin 13 1,442 $103,160.68 ($12,717.38) -12.3% San Luis Obispo 12 1,722 $190,866.48 ($36,453.64) -19.1% Santa Clara 44 6,290 $1,213,907.10 ($117,245.67) <100% Santa Cruz * -- -- -- -- Small Counties 96 12,311 $685,722.70 $341,674.24 49.8% Solano 21 5,221 $209,048.84 ($30,655.72) -14.7% Sonoma 33 5,972 $107,973.76 $34,034.15 31.5% Stanislaus 15 2,118 $135,636.72 ($108,779.26) -80.2% Tulare 3 477 $22,528.71 -- -- Ventura 45 7,539 $412,157.13 ($160,583.41) -39.0% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 61 See Appendix D for County Participants 62 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. 63 When displaying by-county results, outliers were excluded from the tables when outlier status was clearly due to procedural or data-related anomalies. 64 Ibid. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 206 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.2 Full Service Partnership Services – Children, Youth and Families: Expenditures and Cost Offsets FY 09-10 New Enrollees Only 65 Small Counties are grouped together in the table 66 Children, Youth and Families Number of Total FY 09-10 New Enrollees FSP New during Fiscal Enrollee Total Cost Percent of Year 09-10 Sum of Days Expenditure Offset Costs Offset Butte 1 178 $3,307.24 -- -- Contra Costa 42 6,070 $649,793.50 $36,497.74 5.6% 67 Fresno 150 23,533 -- -- -- Kern 16 2,926 $149,460.08 ($11,538..33) -7.7% Los Angeles 1,244 193,819 $9,609,546.02 $403,610.31 4.2% Merced 38 6,980 $237,738.80 ($122,985.14) -51.7% Orange 58 15,967 $879,981.70 ($40,548.65) -4.6% Placer 7 1,168 $64,461.92 $14,687.14 22.8% San Bernardino 459 57,813 $4,208,786.40 $1,281,406.96 30.4% San Diego 616 70,337 $1,107,104.38 $384,010.11 34.7% San Francisco 96 13,615 $349,497.05 $102,432.65 29.3% San Joaquin 48 5,051 $261,439.76 $6,505.93 2.5% San Luis Obispo 64 12.208 $584,885.28 $29,319.79 5.0% Santa Clara 43 6,233 $933,454.08 $323,004.48 34.6% Santa Cruz * -- -- -- -- Small Counties 145 25,563 $904,674.57 ($505,640.47) -55.9% Solano 18 3,026 $121,584.68 $77,577.18 63.8% Sonoma 32 5,439 $58,632.42 $27,007.09 46.1% Stanislaus 14 2,692 $174,037.80 ($32,199.34) -18.5% Tulare 4 1,006 $31,206.12 -- -- Ventura 6 981 $122,556.33 ($2,368.13) -1.9% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 65 See Appendix D for County Participants 66 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Lake, Lassen, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Humboldt, Inyo, Mono and Tehama counties did not provide FSP services in FY 08-09/FY09-10 to CYF, nor claim expenditures for CYF in the study, and are therefore not included in the Small County pool. 67 When displaying by-county results, outliers were excluded from the tables when outlier status was clearly due to procedural or data-related anomalies. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 207 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.3 Full Service Partnership Services – Transition Age Youth: Expenditures and Cost Offsets FY 08-09 New Enrollees Only 68 Small Counties are grouped together in the table 69 Transition Age Youth Number of Total FY 08-09 New Enrollees FSP New during Fiscal Enrollee Total Cost Percent of Year 08-09 Sum of Days Expenditure Offset Costs Offset Butte 27 3,717 $377,907.39 $100,780.17 26.7% Contra Costa 44 8,201 $593,014.31 $124,364.45 21.0% 70 Fresno -- -- -- -- -- Kern 84 12,172 $567,336.92 $591,364..67 104.2% Los Angeles 558 95,088 $6,189,277.92 $8,067,066.07 130.3% Merced 17 2,672 $676,924.48 $61,631.76 9.1% Orange 254 42,480 $1,453,989.60 $6,843,629.56 470.7% Placer 71 -- -- -- -- -- San Bernardino 462 66,976 $2,206,189.44 $948,162.95 43.0% San Diego 182 27,811 $1,222,571.56 $201,762.58 16.5% San Francisco 71 9,781 $284,138.05 $1,542,237.58 542.8% San Joaquin 101 15,129 $594,115.83 $157,457.21 26.5% San Luis Obispo 15 2,700 $263,736.00 $43,607.60 16.5% Santa Clara 73 12,187 $859,307.37 $987,154.28 114.9% Santa Cruz 6 1,626 $110,925.72 ($4,926.46) -4.5% Small Counties 150 21,367 $1,188,432.52 $626,638.20 52.7% Solano 15 4,329 $761,947.29 $84,038.40 11.0% Sonoma 11 1,364 $81,730.88 $341,462.21 417.8% Stanislaus 50 6,742 $124,727.00 $435,438.28 349.1% Tulare 37 5,770 $194,218.20 $191,539.75 98.6% Ventura 71 10,979 $784,778.92 $613,350.22 78.2% 68 See Appendix D for County Participants 69 Small counties included for purpose of FY 08-09 analyses = Alpine, Berkeley, El Dorado, Glenn, Imperial, Lake, Madera, Mendocino, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. 70 Fresno did not report any TAY expenditures, but there are TAY in the DCR. 71 Placer did not report any TAY expenditures, but there are TAY in the DCR. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 208 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.4 Full Service Partnership Services – Transition Age Youth: Expenditures and Cost Offsets FY 09-10 New Enrollees Only 72 Small Counties are grouped together in the table 73 Transition Age Youth Number of Total FY 09-10 New Enrollees FSP New during Fiscal Enrollee Total Cost Percent of Year 09-10 Sum of Days Expenditure Offset Costs Offset Butte 21 3,841 $3,307.24 -- -- Contra Costa 53 10,080 $400,780.80 $416,633.83 104.0% 74 Fresno -- -- -- -- -- Kern 94 13,283 $755,271.38 $1,168,086..28 154.7% Los Angeles 582 101,820 $4,872,087.00 $10,118,011.17 207.7% Merced 18 2,762 $325,695.04 $50,413.51 15.5% Orange 139 35,242 $729,509.40 $3,009,770.55 412.6% Placer 75 -- -- -- -- -- San Bernardino 522 73,615 $1,946,380.60 $3,519,695.62 180.8% San Diego 391 47,373 $1,775,540.04 $2,749,018.84 154.8% San Francisco 71 10,633 $334,407.85 $912,567.45 272.9% San Joaquin 132 24,791 $409,051.50 $858,479.71 209.9% San Luis Obispo 37 6,423 $355,641.51 $30,274.36 8.5% Santa Clara 86 12,530 $823,095.70 $1,582,602.82 114.9% Santa Cruz ** -- -- -- -- -- Small Counties 230 40,338 $1,985,436.36 $1,178,604.22 59.4% Solano 20 4,496 $672,196.96 $475,392.52 70.7% Sonoma 27 3,385 $142,170.00 $589,982.47 415.0% Stanislaus 51 8,172 $125,031.60 $521,515.58 417.1% Tulare 52 6,621 $165,392.58 $238,399.89 144.1% Ventura 338 72,980 $2,238,290.60 $1,477,617.23 66.0% **No new enrollees in FY 09-10 72 See Appendix D for County Participants 73 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. 74 Fresno did not report any TAY expenditures, but there are TAY in the DCR. 75 Placer did not report any TAY expenditures, but there are TAY in the DCR. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 209 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.5 Full Service Partnership Services –Adults: Expenditures and Cost Offsets FY 08-09 New Enrollees Only 76 Small Counties are grouped together in the table 77 Adults Number of Total FY 08-09 New Enrollees FSP New during Fiscal Enrollee Total Cost Percent of Year 08-09 Sum of Days Expenditure Offset Costs Offset Butte 43 43,295 $356,105.05 $242,182.84 68.0% Contra Costa 55 7,446 $1,226,132.82 $129,947.72 10.6% Fresno 246 4,777 $4,301,565.73 $1,801,917.72 41.9% Kern 118 17,946 $637,621.38 $725,917..96 113.8% Los Angeles 1,530 258,915 $18,473,585.25 $35,223,030.97 190.7% Merced 13 1,152 $33,661.44 $234,979.19 698.1% Orange 233 37,577 $2,129,488.59 $4,128,051.66 193.9% Placer 28 6,383 $1,124,812.26 $217,452.74 19.3% San Bernardino 582 74,249 $7,840,694.40 $1,913,044.75 24.4% San Diego 147 28,119 $1,722,007.56 $492,248.11 28.6% San Francisco 179 24,060 $1,874,033.40 $703,854.35 37.6% San Joaquin 359 54,177 $3,000,864.03 $1,169,203.64 39.0% San Luis Obispo 19 1,810 $234,413.10 $95,998.03 41.0% Santa Clara 138 23,564 $3,019,726.60 $4,289,985.59 142.1% Santa Cruz 35 11,131 $616,212.16 $116,908.02 19.0% Small Counties 286 49,105 $4,051,162.50 $2,659,833.58 65.7% Solano 13 1,733 $48,887.93 $85,325.82 174.5% Sonoma 24 4,684 $91,946.92 $203,195.93 221.0% Stanislaus 119 18,072 $1,111,247.28 $915,873.34 82.4% Tulare 95 14,488 $270,490.96 $1,180,221.66 436.3% Ventura 53 4,615 $625,378.65 $298,815.69 47.8% 76 See Appendix D for County Participants 77 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 210 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.6 Full Service Partnership Services –Adults: Expenditures and Cost Offsets FY 09-10 New Enrollees Only 78 Small Counties are grouped together in the table 79 Transition Age Youth Number of Total FY 09-10 New Enrollees FSP New during Fiscal Enrollee Total Cost Percent of Year 09-10 Sum of Days Expenditure Offset Costs Offset Butte 21 3,841 $3,307.24 -- -- Contra Costa 53 10,080 $400,780.80 $416,633.83 104.0% 80 Fresno -- -- -- -- -- Kern 94 13,283 $755,271.38 $1,168,086..28 154.7% Los Angeles 582 101,820 $4,872,087.00 $10,118,011.17 207.7% Merced 18 2,762 $325,695.04 $50,413.51 15.5% Orange 139 35,242 $729,509.40 $3,009,770.55 412.6% Placer 81 -- -- -- -- -- San Bernardino 522 73,615 $1,946,380.60 $3,519,695.62 180.8% San Diego 391 47,373 $1,775,540.04 $2,749,018.84 154.8% San Francisco 71 10,633 $334,407.85 $912,567.45 272.9% San Joaquin 132 24,791 $409,051.50 $858,479.71 209.9% San Luis Obispo 37 6,423 $355,641.51 $30,274.36 8.5% Santa Clara 86 12,530 $823,095.70 $1,582,602.82 114.9% Santa Cruz** -- -- -- -- -- Small Counties 230 40,338 $1,985,436.36 $1,178,604.22 59.4% Solano 20 4,496 $672,196.96 $475,392.52 70.7% Sonoma 27 3,385 $142,170.00 $589,982.47 415.0% Stanislaus 51 8,172 $125,031.60 $521,515.58 417.1% Tulare 52 6,621 $165,392.58 $238,399.89 144.1% Ventura 338 72,980 $2,238,290.60 $1,477,617.23 66.0% **No new enrollees in FY 09-10 78 See Appendix D for County Participants 79 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. 80 When displaying by-county results, outliers were excluded from the tables when outlier status was clearly due to procedural or data-related anomalies. 81 Ibid. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 211 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.7 Full Service Partnership Services –Older Adults: Expenditures and Cost Offsets FY 08-09 New Enrollees Only 82 Small Counties are grouped together in the table 83 Older Adults Number of Total FY 08-09 New Enrollees FSP New during Fiscal Enrollee Total Cost Percent of Year 08-09 Sum of Days Expenditure Offset Costs Offset Butte 2 295 $171.10 -- -- Contra Costa* -- -- -- -- -- Fresno 84 -- -- -- -- -- Kern 1 322 $33,079.06 -- -- Los Angeles 157 24,848 $1,442,426.40 $3,818,766.31 264.7% Merced 85 -- -- -- -- -- Orange 26 3,509 $251,490.03 ($126,677.28) -50.4% Placer 86 -- -- -- -- -- San Bernardino 17 2,134 $99,743.16 ($192,354.02) -192.8% San Diego 66 11,363 $539,742.50 $140,233.25 26.0% San Francisco 34 5,503 $260,291.90 $673,730.10 258.8% San Joaquin 87 11,866 $886,271.54 $287,573.90 32.5% San Luis Obispo 6 787 $241,624.74 $135,150.06 55.9% Santa Clara 11 1,885 $230,196.20 $360,663.64 156.7% Santa Cruz 2 730 $66,984.80 -- -- Small Counties 53 7,751 $662,012.91 $376,064.15 56.8% Solano 12 2,190 $215,233.20 $165,825.92 77.0% Sonoma 1 191 $81,730.88 $30,469.50 246.2% Stanislaus 8 1,326 $83,922.54 $198,283.93 236.3% Tulare 1 184 $9,098.80 -- -- Ventura 62 10,632 $473,017.68 $18,281.10 3.9% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 82 See Appendix D for County Participants 83 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra County did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claimed expenditures for Older Adults in the study, and is therefore not included in the Small County pool. 84 Fresno did not report any OA expenditures, but there are OA in the DCR. 85 When displaying by-county results, outliers were excluded from the tables when outlier status was clearly due to procedural or data-related anomalies. 86 Placer did not report any OA expenditures, but there are OA in the DCR. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 212 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.8 Full Service Partnership Services –Older Adults: Expenditures and Cost Offsets FY 09-10 New Enrollees Only 87 Small Counties are grouped together in the table 88 Older Adults Number of Total FY 09-10 New Enrollees FSP New during Fiscal Enrollee Total Cost Percent of Year 09-10 Sum of Days Expenditure Offset Costs Offset Butte 89 -- -- -- -- -- Contra Costa* -- -- -- -- -- Fresno 90 -- -- -- -- -- Kern 17 2,579 $123,818.79 $62,429.11 50.4% Los Angeles 81 15,208 $781,691.20 $1,440,961.07 184.3% Merced -- -- -- -- -- Orange 41 8,205 $474,002.60 $6,843,629.56 470.7% Placer 91 -- -- -- -- -- San Bernardino 21 3,154 $143,538.54 $289,800.19 201.9% San Diego 102 11,915 $488,395.85 ($35,522.79) -7.3% San Francisco 19 3,974 $173,067.70 $89,098.59 51.5% San Joaquin 72 12,060 $315,170.80 $2,060.17 0.7% San Luis Obispo 8 1,147 $97,368.83 $15,574.87 16.0% Santa Clara 7 1,165 $85,790.60 $187,360.97 -5.1% Santa Cruz** -- -- -- -- -- Small Counties 53 7,751 $662,012.91 $376,064.15 56.8% Solano 9 1,996 $248,841.32 $159,542.54 64.1% Sonoma 50 439 $17,832.18 $490,483.09 2,750.6% Stanislaus 8 1,404 $89,069.76 ($116,436.57) -130.7% Tulare 3 398 $18,996.54 $97,952.01 515.6% Ventura 83 20,860 $771,402.80 $398,208.15 50.8% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study **No new enrollees in FY 09-10 87 See Appendix D for County Participants 88 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Napa, San Benito, Shasta, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra, Colusa, Del Norte, and Mono counties did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and are therefore not included in the Small County pool. 89 When displaying by-county results, outliers were excluded from the tables when outlier status was clearly due to procedural or data-related anomalies. 90 Fresno did not report any OA expenditures, but there are OA in the DCR. 91 Placer did not report any OA expenditures, but there are OA in the DCR. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 213 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.9 Full Service Partnership Services – Children, Youth and Families: Costs and Cost Offsets – Inpatient Psychiatric Hospitalization FY 08-09 New Enrollees Only 92 Small Counties are grouped together in the table 93 Children, Youth, and Families Number of Number of Decrease in Days Per Days Per Post FSP Number of Pre FSP Cost Total Offset Percent Year – Pre Year – Post Cost Days County FSP FSP Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern 0 2 -2 $0.00 $2,168.48 ($2,168.48) 0.0% Los Angeles 1,551 973 578 $811,173.00 $508,879.00 $302,294.00 37.3% Merced 0 35 -35 $0.00 $16,398.15 ($16,398.15) 0.0% Orange 181 58 123 $196,247.44 $62,885.92 $133,361.52 68.0% Placer 59 0 59 $63,970.16 $0.00 $63,970.16 100.0% San Bernardino 177 42 135 $191,910.48 $45,538.08 $146,372.40 76.3% San Diego 28 12 16 $30,358.72 $13,010.88 $17,347.84 57.1% San Francisco 130 32 98 $140,951.20 $34,695.68 $106,255.52 75.4% San Joaquin 10 15 -5 $10,842.40 $16,263.60 ($5,421.20) -50.0% San Luis Obispo 46 112 -66 $49,875.04 $121,434.88 ($71,559.84) -143.5% Santa Clara 41 219 -178 $44,453.84 $237,448.56 $192,994.72) -434.1% Santa Cruz* -- -- -- -- -- -- -- Small Counties 149 238 -89 $150,087.35 $239,736.85 ($89,649.50) -59.7% Solano 14 10 4 $15,179.36 $10,842.40 $4,336.96 28.6% Sonoma 27 17 10 $29,274.48 $18,432.08 $10,842.40 37.0% Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura 14 240 -226 $15,179.36 $260,217.60 ($245,038.24) -1,614.3% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 92 See Appendix D for County Participants 93 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 214 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.10 Full Service Partnership Services – Children, Youth and Families: Inpatient Psychiatric Hospitalization FY 09-10 New Enrollees Only 94 Small Counties are grouped together in the table 95 Children, Youth, and Families Number of Number of Decrease in Days Per Days Per Post FSP Number of Pre FSP Cost Total Offset Percent Year – Pre Year – Post Cost Days County FSP FSP Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern 0 2 -2 $0.00 $2,168.48 ($2,168.48) 0.0% Los Angeles 1,551 973 578 $811,173.00 $508,879.00 $302,294.00 37.3% Merced 0 35 -35 $0.00 $16,398.15 ($16,398.15) 0.0% Orange 181 58 123 $196,247.44 $62,885.92 $133,361.52 68.0% Placer 59 0 59 $63,970.16 $0.00 $63,970.16 100.0% San Bernardino 177 42 135 $191,910.48 $45,538.08 $146,372.40 76.3% San Diego 28 12 16 $30,358.72 $13,010.88 $17,347.84 57.1% San Francisco 130 32 98 $140,951.20 $34,695.68 $106,255.52 75.4% San Joaquin 10 15 -5 $10,842.40 $16,263.60 ($5,421.20) -50.0% San Luis Obispo 46 112 -66 $49,875.04 $121,434.88 ($71,559.84) -143.5% Santa Clara 41 219 -178 $44,453.84 $237,448.56 ($192,994.72) -434.1% Santa Cruz* -- -- -- -- -- -- -- Small Counties 149 238 -89 $150,087.35 $239,736.85 ($89,649.50) -59.7% Solano 14 10 4 $15,179.36 $10,842.40 $4,336.96 28.6% Sonoma 27 17 10 $29,274.48 $18,432.08 $10,842.40 37.0% Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura 14 240 -226 $15,179.36 $260,217.60 ($245,038.24) -1,614.3% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 94 See Appendix D for County Participants 95 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 215 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.11 Full Service Partnership Services – Children, Youth and Families: Inpatient Psychiatric Hospitalization FY 09-10 New Enrollees Only 96 Small Counties are grouped together in the table 97 Children, Youth, and Families Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent – Pre FSP – Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno 163 25 138 $150,775.00 $23,125.00 $127,650.00 84.7% Kern -- -- -- -- -- -- -- Los Angeles 1,778 1,579 199 $929,894.00 $825,817.00 $104,077.00 11.2% Merced 337 0 337 $197,246.10 $0.00 $197,246.10 100.0% Orange 47 29 18 $53,099.66 $32,763.62 $20,336.04 38.3% Placer 13 0 13 $14,687.14 $0.00 $14,687.14 100.0% San Bernardino 516 149 367 $582,966.48 $168,337.22 $414,629.26 71.1% San Diego 477 476 1 $538,905.06 $537,775.28 $1,129.78 0.2% San Francisco 63 39 24 $71,176.14 $44,061.42 $27,114.72 38.1% San Joaquin 35 0 35 $39,542.30 $0.00 $39,542.30 100.0% San Luis Obispo 16 4 12 $18,076.48 $4,519.12 $13,557.36 75.0% Santa Clara 44 191 -147 $49,710.32 $215,787.98 ($166,077.66) -334.1% Santa Cruz* -- -- -- -- -- -- -- Small Counties 69 11 58 $71,232.00 $11,355.83 $59,876.17 84.1% Solano 0 6 -6 $0.00 $6,778.68 ($6,778.68) 0.0% Sonoma 58 40 18 $65,527.24 $45,191.20 $20,336.04 31.0% Stanislaus 5 2 3 $5,648.90 $2,259.56 $3,389.34 60.0% Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 96 See Appendix D for County Participants 97 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Lake, Lassen, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Humboldt, Inyo, Mono and Tehama counties did not provide FSP services in FY 08-09/FY 09-10 to CYF, nor claim expenditures for CYF in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 216 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.12 Full Service Partnership Services – Transition Age Youth: Inpatient Psychiatric Hospitalization FY 08-09 New Enrollees Only 98 Small Counties are grouped together in the table 99 Transition Age Youth Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year Pre FSP Year Post FSP Days County Butte 128 2 126 $94,919.68 $1,483.12 $93,436.56 98.4% Contra Costa 104 44 60 $112,760.96 $47,706.56 $65,054.40 57.7% Fresno 1,925 224 1,701 $1,636,250.00 $190,400.00 $1,445,850.00 88.4% Kern 521 221 300 $564,889.04 $239,617.04 $325,272.00 57.6% Los Angeles 4,379 1,104 3,275 $2,290,217.00 $577,392.00 $1,712,825.00 74.8% Merced 212 20 192 $99,325.93 $9,370.37 $89,955.56 90.6% Orange 1,331 765 566 $1,443,123.44 $829,443.60 $613,679.84 42.5% Placer 118 326 -208 $127,940.32 $353,462.24 ($225,521.92) -176.3% San Bernardino 1,184 985 199 $1,283,740.16 $1,067,976.40 $215,763.76 16.8% San Diego 894 1,203 -309 $969,310.56 $1,304,340.72 ($335,030.16) -34.6% San Francisco 590 198 392 $639,701.60 $214,679.52 $425,022.08 66.4% San Joaquin 132 247 -115 $143,119.68 $267,807.28 ($124,687.60) -87.1% San Luis Obispo 47 7 40 $50,959.28 $7,589.68 $43,369.60 85.1% Santa Clara 765 349 416 $829,443.60 $378,399.76 $451,043.84 54.4% Santa Cruz 157 20 137 $11,882.76 $1,513.73 $10,369.03 87.3% Small Counties 597 326 271 601,356.71 328,379.04 272,977.67 45.4% Solano 15 0 15 $16,263.60 $0.00 $16,263.60 100.0% Sonoma 213 1 212 $230,943.12 $1,084.24 $229,858.88 99.5% Stanislaus 278 98 180 $301,418.72 $106,255.52 $195,163.20 64.7% Tulare 86 53 33 $49,577.42 $30,553.53 $19,023.89 38.4% Ventura 326 141 185 $353,462.24 $152,877.84 $200,584.40 56.7% 98 See Appendix D for County Participants 99 Small counties included for purpose of FY 08-09 analyses = Alpine, Berkeley, El Dorado, Glenn, Imperial, Lake, Madera, Mendocino, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 217 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.13 Full Service Partnership Services – Transition Age Youth: Inpatient Psychiatric Hospitalization FY 09-10 New Enrollees Only 100 Small Counties are grouped together in the table 101 Transition Age Youth Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte 179 47 132 $132,739.24 $34,853.32 $97,885.92 73.7% Contra Costa 445 308 137 $502,752.10 $347,972.24 $154,779.86 30.8% Fresno 582 366 216 $538,350.00 $338,550.00 $199,800.00 37.1% Kern 299 85 214 $337,804.22 $96,031.30 $241,772.92 71.6% Los Angeles 4,856 1,832 3,024 $2,539,688.00 $958,136.00 $1,581,552.00 62.3% Merced 95 263 -168 $55,603.50 $153,933.90 ($98,330.40) -176.8% Orange 351 142 209 $396,552.78 $160,428.76 $236,124.02 59.5% Placer 303 27 276 $342,323.34 $30,504.06 $311,819.28 91.1% San Bernardino 488 189 299 $551,332.64 $213,528.42 $337,804.22 61.3% San Diego 2,249 1,263 986 $2,540,875.22 $1,426,912.14 $1,113,963.08 43.8% San Francisco 482 10 472 $544,553.96 $11,297.80 $533,256.16 97.9% San Joaquin 826 220 606 $933,198.28 $248,551.60 $684,646.68 73.4% San Luis Obispo 107 81 26 $120,886.46 $91,512.18 $29,374.28 24.3% Santa Clara 178 237 -59 $201,100.84 $267,757.86 ($66,657.02) -33.1% Santa Cruz** -- -- -- -- -- -- -- Small Counties 594 428 166 $613,214.64 $441,844.90 $171,369.74 27.9% Solano 50 0 50 $56,489.00 $0.00 $56,489.00 100.0% Sonoma 406 82 324 $458,690.68 $92,641.96 $366,048.72 79.8% Stanislaus 453 254 199 $511,790.34 $286,964.12 $224,826.22 43.9% Tulare 188 101 87 $212,398.64 $114,107.78 $98,290.86 46.3% Ventura 940 378 562 $1,061,993.20 $427,056.84 $634,936.36 59.8% **No new enrollees in FY 09-10 100 See Appendix D for County Participants 101 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 218 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.14 Full Service Partnership Services – Adults: Inpatient Psychiatric Hospitalization FY 08-09 New Enrollees Only 102 Small Counties are grouped together in the table 103 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County Pre FSP Post FSP Days Butte 178 8 170 $131,997.68 $5,932.48 $126,065.20 95.5% Contra Costa 230 0 230 $249,375.20 $0.00 $249,375.20 100.0% Fresno 2,326 695 1,631 $1,977,100.00 $590,750.00 $1,386,350.00 70.1% Kern 566 569 -3 $613,679.84 $616,932.56 ($3,252.72) -0.5% Los Angeles 19,105 7,589 11,516 $9,991,915.00 $3,969,047.00 $6,022,868.00 60.3% Merced 320 97 223 $149,925.93 $45,446.30 $104,479.63 69.7% Orange 3,933 1,232 2,701 $4,264,315.92 $1,335,783.68 $2,928,532.24 68.7% Placer 326 176 150 $353,462.24 $190,826.24 $162,636.00 46.0% San Bernardino 4,045 2,543 1,502 $4,385,750.80 $2,757,222.32 $1,628,528.48 37.1% San Diego 1,151 1,327 -176 $1,247,960.24 $1,438,786.48 ($190,826.24) -15.3% San Francisco 1,392 533 859 $1,509,262.08 $577,899.92 $931,362.16 61.7% San Joaquin 513 273 240 $556,215.12 $295,997.52 $260,217.60 46.8% San Luis Obispo 129 16 113 $139,866.96 $17,347.84 $122,519.12 87.6% Santa Clara 1,221 767 454 $1,323,857.04 $831,612.08 $492,244.96 37.2% Santa Cruz 102 0 102 $7,720.01 $0.00 $7,720.01 100.0% Small Counties 2,212 1,316 896 $2,228,142.45 $1,325,603.74 $902,538.71 40.5% Solano 41 26 15 $44,453.84 $28,190.24 $16,263.60 36.6% Sonoma 135 82 53 $146,372.40 $88,907.68 $57,464.72 39.3% Stanislaus 709 244 465 $768,726.16 $264,554.56 $504,171.60 65.6% Tulare 1,460 531 929 $841,663.25 $306,111.77 $535,551.48 63.6% Ventura 1,148 1,382 -234 $1,244,707.52 $1,498,419.68 ($253,712.16) -20.4% 102 See Appendix D for County Participants 103 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 219 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.15 Full Service Partnership Services – Adults: Inpatient Psychiatric Hospitalization FY 09-10 New Enrollees Only 104 Small Counties are grouped together in the table 105 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte 972 43 929 $720,796.32 $31,887.08 $688,909.24 95.6% Contra Costa 32 0 32 $36,152.96 $0.00 $36,152.96 100.0% Fresno 1,815 1,195 620 $1,678,875.00 $1,105,375.00 $573,500.00 34.2% Kern 2,662 410 2,252 $3,007,474.36 $463,209.80 $2,544,264.56 84.6% Los Angeles 17,314 5,834 11,480 $9,055,222.00 $3,051,182.00 $6,004,040.00 66.3% Merced 102 77 25 $59,700.60 $45,068.10 $14,632.50 24.5% Orange 1,041 784 257 $1,176,100.98 $885,747.52 $290,353.46 24.7% Placer 516 339 177 $582,966.48 $382,995.42 $199,971.06 34.3% San Bernardino 2,624 691 1,933 $2,964,542.72 $780,677.98 $2,183,864.74 73.7% San Diego 10,527 7,220 3,307 $11,893,194.06 $8,157,011.60 $3,736,182.46 31.4% San Francisco 901 215 686 $1,017,931.78 $242,902.70 $775,029.08 76.1% San Joaquin 3,375 1,355 2,020 $3,813,007.50 $1,530,851.90 $2,282,155.60 59.9% San Luis Obispo 275 89 186 $310,689.50 $100,550.42 $210,139.08 67.6% Santa Clara 2,123 1,716 407 $2,398,522.94 $1,938,702.48 $459,820.46 19.2% Santa Cruz** -- -- -- -- -- -- -- Small Counties 3,592 1,704 1,888 $3,708,193.61 $1,759,120.80 $1,949,072.81 52.6% Solano 146 106 40 $164,947.88 $119,756.68 $45,191.20 27.4% Sonoma 102 55 47 $115,237.56 $62,137.90 $53,099.66 46.1% Stanislaus 426 167 259 $481,286.28 $188,673.26 $292,613.02 60.8% Tulare 1,140 186 954 $1,287,949.20 $210,139.08 $1,077,810.12 83.7% Ventura 1,636 1,519 117 $1,848,320.08 $1,716,135.82 $132,184.26 7.2% **No new enrollees in FY 09-10 104 See Appendix D for County Participants 105 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 220 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.16 Full Service Partnership Services – Older Adults: Inpatient Psychiatric Hospitalization FY 08-09 New Enrollees Only 106 Small Counties are grouped together in the table 107 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno 74 16 58 $62,900.00 $13,600.00 $49,300.00 78.4% Kern 152 266 -114 $164,804.48 $288,407.84 ($123,603.36) -75.0% Los Angeles 2,443 708 1,735 $1,277,689.00 $370,284.00 $907,405.00 71.0% Merced 10 0 10 $4,685.19 $0.00 $4,685.19 100.0% Orange 103 40 63 $111,676.72 $43,369.60 $68,307.12 61.2% Placer 304 109 195 $329,608.96 $118,182.16 $211,426.80 64.1% San Bernardino 38 54 -16 $41,201.12 $58,548.96 ($17,347.84) -42.1% San Diego 129 0 129 $139,866.96 $0.00 $139,866.96 100.0% San Francisco 207 51 156 $224,437.68 $55,296.24 $169,141.44 75.4% San Joaquin 201 65 136 $217,932.24 $70,475.60 $147,456.64 67.7% San Luis Obispo 40 6 34 $43,369.60 $6,505.44 $36,864.16 85.0% Santa Clara 165 50 115 $178,899.60 $54,212.00 $124,687.60 69.7% Santa Cruz -- -- -- -- -- -- -- Small Counties 246 137 109 $247,795.23 $137,999.78 $109,795.45 44.3% Solano 7 11 -4 $7,589.68 $11,926.64 ($4,336.96) -57.1% Sonoma -- -- -- -- -- -- -- Stanislaus 167 11 156 $181,068.08 $11,926.64 $169,141.44 93.4% Tulare -- -- -- -- -- -- -- Ventura 128 115 13 $138,782.72 $124,687.60 $14,095.12 10.2% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 106 See Appendix D for County Participants 107 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra County did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and is therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 221 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.17 Full Service Partnership Services – Older Adults: Inpatient Psychiatric Hospitalization FY 09-10 New Enrollees Only 108 Small Counties are grouped together in the table 109 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County – Pre FSP – Post FSP Days Butte 28 6 22 $20,763.68 $4,449.36 $16,314.32 78.6% Contra Costa* -- -- -- -- -- -- -- Fresno 30 0 30 $27,750.00 $0.00 $27,750.00 100.0% Kern 144 51 93 $162,688.32 $57,618.78 $105,069.54 64.6% Los Angeles 2,247 430 1,817 $1,175,181.00 $224,890.00 $950,291.00 80.9% Merced -- -- -- -- -- -- -- Orange 154 51 103 $173,986.12 $57,618.78 $116,367.34 66.9% Placer 56 1 55 $63,267.68 $1,129.78 $62,137.90 98.2% San Bernardino 223 30 193 $251,940.94 $33,893.40 $218,047.54 86.5% San Diego 652 896 -244 $736,616.56 $1,012,282.88 ($275,666.32) -37.4% San Francisco 75 10 65 $84,733.50 $11,297.80 $73,435.70 86.7% San Joaquin 192 85 107 $216,917.76 $96,031.30 $120,886.46 55.7% San Luis Obispo 67 57 10 $75,695.26 $64,397.46 $11,297.80 14.9% Santa Clara 150 299 -149 $169,467.00 $337,804.22 ($168,337.22) -99.3% Santa Cruz** -- -- -- -- -- -- -- Small Counties 795 364 431 $820,716.57 $375,774.63 $444,941.94 54.2% Solano 108 19 89 $122,016.24 $21,465.82 $100,550.42 82.4% Sonoma 294 188 106 $332,155.32 $212,398.64 $119,756.68 36.1% Stanislaus 45 46 -1 $50,840.10 $51,969.88 ($1,129.78) -2.2% Tulare -- -- -- -- -- -- -- Ventura 146 4 142 $164,947.88 $4,519.12 $160,428.76 97.3% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study **No new enrollees in FY 09-10 108 See Appendix D for County Participants 109 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Napa, San Benito, Shasta, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra, Colusa, Del Norte, and Mono counties did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditure for Older Adults in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 222 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.18 Full Service Partnership Services – Children, Youth and Families: Inpatient Skilled Nursing (Psychiatric) FY 08-09 New Enrollees Only 110 Small Counties are grouped together in the table 111 Children, Youth, and Families Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Days County FSP FSP Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz* -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 110 See Appendix D for County Participants 111 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 223 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.19 Full Service Partnership Services – Children, Youth and Families: Inpatient Skilled Nursing (Psychiatric) FY 09-10 New Enrollees Only 112 Small Counties are grouped together in the table 113 Children, Youth, and Families Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent – Pre FSP – Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz* -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 112 See Appendix D for County Participants 113 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Lake, Lassen, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Humboldt, Inyo, Mono and Tehama counties did not provide FSP services in FY 08-09/FY 09-10 to CYF, nor claim expenditures for CYF in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 224 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.20 Full Service Partnership Services – Transition Age Youth: Inpatient Skilled Nursing (Psychiatric) FY 08-09 New Enrollees Only 114 Small Counties are grouped together in the table 115 Transition Age Youth Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year Pre FSP Year Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno 21 0 21 $6,213.06 $0.00 $6,213.06 100.0% Kern -- -- -- -- -- -- -- Los Angeles 8 0 8 $2,366.88 $0.00 $2,366.88 100.0% Merced -- -- -- -- -- -- -- Orange 30 2 28 $9,599.98 $640.00 $8,959.98 93.3% Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco 0 34 -34 $0.00 $6,911.86 ($6,911.86) 0.0% San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz 46 86 -40 $5,300.35 $9,909.35 ($4,609.00) -87.0% Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- 114 See Appendix D for County Participants 115 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 225 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.21 Full Service Partnership Services – Transition Age Youth: Inpatient Skilled Nursing (Psychiatric) FY 09-10 New Enrollees Only 116 Small Counties are grouped together in the table 117 Transition Age Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno 0 6 -6 $0.00 $1,970.43 - $1,970.43 0.0% Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino 6 0 6 $1,138.13 $0.00 $1,138.13 100.0% San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara 63 0 63 $13,058.64 $0.00 $13,058.64 100.0% Santa Cruz** -- -- -- -- -- -- -- Small Counties 0 253 -253 $0.00 $59,170.05 ($59,170.05) 0.0% Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- **No new enrollees in FY 09-10 116 See Appendix D for County Participants 117 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 226 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.22 Full Service Partnership Services – Adults: Inpatient Skilled Nursing (Psychiatric) FY 08-09 New Enrollees Only 118 Small Counties are grouped together in the table 119 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County Pre FSP Post FSP Days Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno 287 45 242 $84,911.82 $13,313.70 $71,598.12 84.3% Kern 37 2 35 $7,521.73 $406.58 $7,115.15 94.6% Los Angeles 1,051 225 826 $310,948.86 $66,568.50 $244,380.36 78.6% Merced -- -- -- -- -- -- -- Orange 111 26 85 $35,519.93 $8,319.98 $27,199.95 76.6% Placer 0 1 -1 $0.00 $223.60 ($223.60) 0.0% San Bernardino 7 5 2 $1,196.23 $854.45 $341.78 28.6% San Diego 0 200 -200 $0.00 $37,348.00 ($37,348.00) 0.0% San Francisco 304 149 155 $61,800.16 $30,290.21 $31,509.95 51.0% San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara 0 13 -13 $0.00 $2,427.62 ($2,427.62) 0.0% Santa Cruz 182 0 182 $20,970.95 $0.00 $20,970.95 100.0% Small Counties 25 0 25 $5,562.15 $0.00 $5,562.15 100.0% Solano -- -- -- -- -- -- -- Sonoma 56 0 56 $7,428.40 $0.00 $7,428.40 100.0% Stanislaus 0 1 -1 $0.00 $318.13 ($318.13) 0.0% Tulare -- -- -- -- -- -- -- Ventura 222 7 215 $45,130.38 $1,423.03 $43,707.35 96.8% 118 See Appendix D for County Participants 119 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 227 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.23 Full Service Partnership Services – Adults: Inpatient Skilled Nursing (Psychiatric) FY 09-10 New Enrollees Only 120 Small Counties are grouped together in the table 121 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte 545 0 545 $172,519.64 $0.00 $172,519.64 100.0% Contra Costa -- -- -- -- -- -- -- Fresno 150 68 82 $49,260.69 $22,331.51 $26,929.18 54.7% Kern -- -- -- -- -- -- -- Los Angeles 613 267 346 $201,312.02 $87,684.03 $113,627.99 56.4% Merced -- -- -- -- -- -- -- Orange 0 168 -168 $0.00 $59,673.48 ($59,673.48) 0.0% Placer 84 0 84 $26,060.58 $0.00 $26,060.58 100.0% San Bernardino 385 0 385 $73,029.84 $0.00 $73,029.84 100.0% San Diego 2,147 2,108 39 $445,033.17 $436,949.19 $8,083.98 1.8% San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo 60 0 60 $7,674.32 $0.00 $7,674.32 100.0% Santa Clara 58 12 46 $12,022.24 $2,487.36 $9,534.88 79.3% Santa Cruz** -- -- -- -- -- -- -- Small Counties 742 40 702 $173,534.30 $9,354.95 $164,179.35 94.6% Solano -- -- -- -- -- -- -- Sonoma 150 0 150 $22,086.23 $0.00 $22,086.23 100.0% Stanislaus -- -- -- -- -- -- -- Tulare 281 0 281 $87,178.85 $0.00 $87,178.85 100.0% Ventura 150 0 150 $33,847.79 $0.00 $33,847.79 100.0% **No new enrollees in FY 09-10 120 See Appendix D for County Participants 121 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 228 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.24 Full Service Partnership Services – Older Adults: Inpatient Skilled Nursing (Psychiatric) FY 08-09 New Enrollees Only 122 Small Counties are grouped together in the table 123 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern 90 0 90 $18,296.10 $0.00 $18,296.10 100.0% Los Angeles 653 135 518 $193,196.58 $39,941.10 $153,255.48 79.3% Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino 0 9 -9 $0.00 $1,538.01 ($1,538.01) 0.0% San Diego -- -- -- -- -- -- -- San Francisco 164 0 164 $33,339.56 $0.00 $33,339.56 100.0% San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara 305 0 305 $56,955.70 $0.00 $56,955.70 100.0% Santa Cruz -- -- -- -- -- -- -- Small Counties 0 23 -23 $0.00 $5,117.18 ($5,117.18) 0.0% Solano 14 0 14 $5,460.14 $0.00 $5,460.14 100.0% Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura 0 142 -142 $0.00 $28,867.18 ($28,867.18) 0.0% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 122 See Appendix D for County Participants 123 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra County did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claimed expenditures for Older Adults in the study, and is therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 229 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.25 Full Service Partnership Services – Older Adults: Inpatient Skilled Nursing (Psychiatric) FY 09-10 New Enrollees Only 124 Small Counties are grouped together in the table 125 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County – Pre FSP – Post FSP Days Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern 10 0 10 $2,256.52 $0.00 $2,256.52 100.0% Los Angeles 275 0 275 $90,311.27 $0.00 $90,311.27 100.0% Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino 196 0 196 $37,178.83 $0.00 $37,178.83 100.0% San Diego 424 157 267 $87,887.31 $32,543.18 $55,344.13 63.0% San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo 0 6 -6 $0.00 $127.91 ($127.91) 0.0% Santa Clara -- -- -- -- -- -- -- Santa Cruz** -- -- -- -- -- -- -- Small Counties 766 432 334 $179,147.27 $101,033.45 $78,113.82 43.6% Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura 136 0 136 $30,688.66 $0.00 $30,688.66 100.0% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study **No new enrollees in FY 09-10 124 See Appendix D for County Participants 125 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Napa, San Benito, Shasta, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra, Colusa, Del Norte, and Mono counties did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 230 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.26 Full Service Partnership Services – Children, Youth and Families: Long Term Care FY 08-09 New Enrollees Only 126 Small Counties are grouped together in the table 127 Children, Youth, and Families Number of Number of Decrease in Days Per Days Per Post FSP Number of Pre FSP Cost Total Offset Percent Year – Pre Year – Post Cost Days County FSP FSP Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz* -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 126 See Appendix D for County Participants 127 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 231 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.27 Full Service Partnership Services – Children, Youth and Families: Long Term Care FY 09-10 New Enrollees Only 128 Small Counties are grouped together in the table 129 Children, Youth, and Families Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent – Pre FSP – Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz* -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 128 See Appendix D for County Participants 129 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Lake, Lassen, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Humboldt, Inyo, Mono and Tehama counties did not provide FSP services in FY 08-09/FY 09-10 to CYF, nor claim expenditures for CYF in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 232 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.28 Full Service Partnership Services – Transition Age Youth: Long Term Care FY 08-09 New Enrollees Only 130 Small Counties are grouped together in the table 131 Transition Age Youth Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year Pre FSP Year Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa 88 19 69 $17,673.33 $3,815.83 $13,857.50 78.4% Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles 2,064 0 2,064 $387,879.58 $0.00 $387,879.58 100.0% Merced -- -- -- -- -- -- -- Orange 30 0 30 $6,020.10 $0.00 $6,020.10 100.0% Placer -- -- -- -- -- -- -- San Bernardino 89 10 79 $15,040.11 $1,689.90 $13,350.21 88.8% San Diego 272 242 30 $54,382.66 $48,340.59 $6,042.07 11.1% San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara 147 196 -49 $27,481.65 $36,642.20 ($9,160.55) -33.3% Santa Cruz 0 65 -65 $0.00 $10,798.36 ($10,798.36) 0.0% Small Counties 906 0 906 $153,115.17 $0.00 $153,115.17 100.0% Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare 24 0 24 $4,475.36 $0.00 $4,475.36 100.0% Ventura 1,091 0 1,091 $123,375.74 $0.00 $123,375.74 100.0% 130 See Appendix D for County Participants 131 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 233 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.29 Full Service Partnership Services – Transition Age Youth: Long Term Care FY 09-10 New Enrollees Only 132 Small Counties are grouped together in the table 133 Transition Age Youth Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte 249 8 241 $44,149.57 $1,418.46 $42,731.11 96.8% Contra Costa 86 0 86 $18,466.77 $0.00 $18,466.77 100.0% Fresno 185 0 185 $43,020.83 $0.00 $43,020.83 100.0% Kern -- -- -- -- -- -- -- Los Angeles 5,519 33 5,486 $1,067,226.01 $6,381.31 $1,060,844.70 99.4% Merced -- -- -- -- -- -- -- Orange 90 0 90 $20,046.93 $0.00 $20,046.93 100.0% Placer -- -- -- -- -- -- -- San Bernardino 2 0 2 $366.16 $0.00 $366.16 100.0% San Diego 2,034 0 2,034 $414,824.86 $0.00 $414,824.86 100.0% San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara 346 479 -133 $62,750.56 $86,871.44 ($24,120.88) -38.4% Santa Cruz** -- -- -- -- -- -- -- Small Counties 154 94 60 $28,127.36 $17,168.65 $10,958.71 39.0% Solano -- -- -- -- -- -- -- Sonoma 90 0 90 $16,433.64 $0.00 $16,433.64 100.0% Stanislaus -- -- -- -- -- -- -- Tulare 66 0 66 $13,661.04 $0.00 $13,661.04 100.0% Ventura 201 0 201 $25,230.39 $0.00 $25,230.39 100.0% **No new enrollees in FY 09-10 132 See Appendix D for County Participants 133 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 234 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.30 Full Service Partnership Services – Adults: Long Term Care FY 08-09 New Enrollees Only 134 Small Counties are grouped together in the table 135 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County Pre FSP Post FSP Days Butte -- -- -- -- -- -- -- Contra Costa 116 0 116 $23,296.67 $0.00 $23,296.67 100.0% Fresno 0 312 -312 $0.00 71,444.88 ($71,444.88) 0.0% Kern 144 3 141 $28,437.12 $592.44 $27,844.68 97.9% Los Angeles 20,508 390 20,118 $3,853,989.56 $73,291.20 $3,780,698.36 98.1% Merced -- -- -- -- -- -- -- Orange 584 0 584 $117,191.28 $0.00 $117,191.28 100.0% Placer 817 0 817 $138,073.00 $0.00 $138,073.00 100.0% San Bernardino 3,212 531 2,681 $542,795.88 $89,733.69 $453,062.19 83.5% San Diego 77 154 -77 $15,395.09 $30,850.16 ($15,455.07) -100.4% San Francisco 2,677 654 2,023 $520,676.50 $127,142.71 $393,533.79 75.6% San Joaquin 0 3 -3 $0.00 $576.83 ($576.83) 0.0% San Luis Obispo -- -- -- -- -- -- -- Santa Clara 5,241 459 4,782 $979,804.95 $85,810.05 $893,994.90 91.2% Santa Cruz 44 0 44 $7,264.95 $0.00 $7,264.95 100.0% Small Counties 7,911 561 7,350 $1,336,969.21 $94,809.72 $1,242,159.49 92.9% Solano 40 0 40 $8,170.00 $0.00 $8,170.00 100.0% Sonoma 259 113 146 $43,427.83 $18,947.28 $24,480.55 56.4% Stanislaus 85 0 85 $14,787.03 $0.00 $14,787.03 100.0% Tulare 2,262 17 2,245 $421,802.68 $3,220.39 $418,582.29 99.2% Ventura 2,804 0 2,804 $317,090.34 $0.00 $317,090.34 100.0% 134 See Appendix D for County Participants 135 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 235 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.31 Full Service Partnership Services – Adults: Long Term Care FY 09-10 New Enrollees Only 136 Small Counties are grouped together in the table 137 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa 196 138 58 $42,087.06 $29,632.73 $12,454.33 29.6% Fresno 409 0 409 $95,110.91 $0.00 $95,110.91 100.0% Kern 330 0 330 $72,215.55 $0.00 $72,215.55 100.0% Los Angeles 31,139 90 31,049 $6,021,444.24 $17,403.58 $6,004,040.66 99.7% Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer 212 254 -42 $38,812.96 $46,502.32 ($7,689.36) -19.8% San Bernardino 186 1 185 $34,052.88 $183.08 $33,869.80 99.5% San Diego 13,306 585 12,721 $2,713,696.92 $119,363.10 $2,594,333.82 95.6% San Francisco 580 326 254 $112,810.00 $63,463.41 $49,346.59 43.7% San Joaquin 740 547 193 $157,934.69 $116,743.61 $41,191.08 26.1% San Luis Obispo -- -- -- -- -- -- -- Santa Clara 4,341 328 4,013 $787,283.76 $59,486.08 $727,797.68 92.4% Santa Cruz** -- -- -- -- -- -- -- Small Counties 4,627 299 4,328 $845,099.44 $54,610.92 $790,488.52 93.5% Solano 628 68 560 $128,269.00 $13,880.83 $114,388.17 89.2% Sonoma 358 8 350 $65,369.38 $1,460.77 $63,908.61 97.8% Stanislaus -- -- -- -- -- -- -- Tulare 624 292 332 $129,158.89 $60,439.74 $68,719.15 53.2% Ventura 3,007 0 3,007 $377,451.72 $0.00 $377,451.72 100.0% **No new enrollees in FY 09-10 136 See Appendix D for County Participants 137 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 236 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.32 Full Service Partnership Services – Older Adults: Long Term Care FY 08-09 New Enrollees Only 138 Small Counties are grouped together in the table 139 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern 414 0 414 $81,756.72 $0.00 $81,756.72 100.0% Los Angeles 2,145 1 2,144 $403,101.60 $187.93 $402,913.67 100.0% Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino 364 40 324 $61,512.36 $6,759.60 $54,752.76 89.0% San Diego 179 0 179 $35,788.59 $0.00 $35,788.59 100.0% San Francisco 295 107 188 $57,377.50 $20,875.69 $36,501.81 63.6% San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara 340 0 340 $63,563.00 $0.00 $63,563.00 100.0% Santa Cruz -- -- -- -- -- -- -- Small Counties 1,013 0 1,013 $171,198.31 $0.00 $171,198.31 100.0% Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura 408 0 408 $46,138.68 $0.00 $46,138.68 100.0% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 138 See Appendix D for County Participants 139 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra County did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claimed expenditures for Older Adults in the study, and is therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 237 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.33 Full Service Partnership Services – Older Adults: Long Term Care FY 09-10 New Enrollees Only 140 Small Counties are grouped together in the table 141 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County – Pre FSP – Post FSP Days Butte 323 0 323 $57,270.32 $0.00 $57,270.32 100.0% Contra Costa* -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles 1,373 0 1,373 $265,501.23 $0.00 $265,501.23 100.0% Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino 370 0 370 $67,739.60 $0.00 $67,739.60 100.0% San Diego 188 0 188 $38,341.73 $0.00 $38,341.73 100.0% San Francisco 193 0 193 $37,538.50 $0.00 $37,538.50 100.0% San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara 223 0 223 $40,443.28 $0.00 $40,443.28 100.0% Santa Cruz** -- -- -- -- -- -- -- Small Counties 3,314 304 3,010 $605,286.26 $55,524.15 $549,762.11 90.8% Solano -- -- -- -- -- -- -- Sonoma 42 0 42 $7,669.03 $0.00 $7,669.03 100.0% Stanislaus -- -- -- -- -- -- -- Tulare 1 0 1 $206.99 $0.00 $206.99 100.0% Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study **No new enrollees in FY 09-10 140 See Appendix D for County Participants 141 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Napa, San Benito, Shasta, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra, Colusa, Del Norte, and Mono counties did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 238 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.34 Full Service Partnership Services – Children, Youth and Families: Inpatient Hospitalization (Physical) FY 08-09 New Enrollees Only 142 Small Counties are grouped together in the table 143 Children, Youth, and Families Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Days County FSP FSP Butte -- -- -- -- -- -- -- Contra Costa 2 0 2 $7,881.23 $0.00 $7,881.23 100.0% Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles 468 165 303 $1,031,004.00 $363,495.00 $667,509.00 64.7% Merced 0 1 -1 $0.00 $2,234.92 ($2,234.92) 0.0% Orange 0 7 -7 $0.00 $18,498.34 ($18,498.34) 0.0% Placer -- -- -- -- -- -- -- San Bernardino 29 0 29 $66,991.45 $0.00 $66,991.45 100.0% San Diego 0 6 -6 $0.00 $14,549.41 ($14,549.41) 0.0% San Francisco 14 34 -20 $50,456.59 $122,537.43 ($72,080.84) -142.9% San Joaquin 0 11 -11 $0.00 $27,529.92 ($27,529.92) 0.0% San Luis Obispo 10 0 10 $26,336.91 $0.00 $26,336.91 100.0% Santa Clara 38 0 38 $162,258.10 $0.00 $162,258.10 100.0% Santa Cruz* -- -- -- -- -- -- -- Small Counties 48 53 -5 $122,208.26 $134,938.29 ($12,730.03) -10.4% Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus 2 2 0 $3,947.88 $3,947.88 $0.00 0.0% Tulare -- -- -- -- -- -- -- Ventura 0 3 -3 $0.00 $6,750.93 ($6,750.93) 0.0% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 142 See Appendix D for County Participants 143 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized cost per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 239 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.35 Full Service Partnership Services – Children, Youth and Families: Inpatient Hospitalization (Physical) FY 09-10 New Enrollees Only 144 Small Counties are grouped together in the table 145 Children, Youth, and Families Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent – Pre FSP – Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern 1 0 1 $2,205.55 $0.00 $2,205.55 100.0% Los Angeles 128 237 -109 $309,504.00 $573,066.00 ($263,562.00) -85.2% Merced 5 0 5 $12,175.94 $0.00 $12,175.94 100.0% Orange 7 12 -5 $19,531.54 $33,482.64 ($13,951.10) -71.4% Placer -- -- -- -- -- -- -- San Bernardino 90 162 -72 $218,489.40 $393,280.92 ($174,791.52) -80.0% San Diego 81 12 69 $215,037.45 $31,857.40 $183,180.05 85.2% San Francisco 18 7 11 $69,548.98 $27,046.83 $42,502.15 61.1% San Joaquin 2 32 -30 $5,192.84 $83,085.44 ($77,892.60) -1,500.0% San Luis Obispo 6 0 6 $16,931.56 $0.00 $16,931.56 100.0% Santa Clara 60 0 60 $283,903.80 $0.00 $283,903.80 100.0% Santa Cruz* -- -- -- -- -- -- -- Small Counties 0 233 -233 $0.00 $623,590.90 ($623,590.90) 0.0% Solano 21 0 21 $82,906.34 $0.00 $82,906.34 100.0% Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- 144 See Appendix D for County Participants 145 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Lake, Lassen, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Humboldt, Inyo, Mono and Tehama counties did not provide FSP services in FY 08-09/FY 09-10 to CYF, nor claim expenditures for CYF in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 240 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.36 Full Service Partnership Services – Transition Age Youth: Inpatient Hospitalization (Physical) FY 08-09 New Enrollees Only 146 Small Counties are grouped together in the table 147 Transition Age Youth Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year Pre FSP Year Post FSP Days County Butte 1 6 -5 $2,365.71 $14,194.27 ($11,828.56) -500.0% Contra Costa 7 7 0 $27,584.31 $27,584.31 $0.00 0.0% Fresno 0 31 -31 $0.00 $63,999.50 ($63,999.50) 0.0% Kern 30 0 30 $61,219.80 $0.00 $61,219.80 100.0% Los Angeles 470 255 215 $1,035,410.00 $561,765.00 $473,645.00 45.7% Merced 9 10 -1 $20,114.28 $22,349.20 ($2,234.92) -11.1% Orange 154 47 107 $406,963.48 $124,203.14 $282,760.34 69.5% Placer 0 18 -18 $0.00 $58,637.70 ($58,637.70) 0.0% San Bernardino 430 739 -309 $993,321.50 $1,707,126.95 ($713,805.45) -71.9% San Diego 283 214 69 $686,247.32 $518,929.07 $167,318.25 24.4% San Francisco 148 5 143 $533,398.20 $18,020.21 $515,377.99 96.6% San Joaquin 8 6 2 $20,021.76 $15,016.32 $5,005.44 25.0% San Luis Obispo -- -- -- -- -- -- -- Santa Clara 19 156 -137 $81,129.05 $666,112.20 ($584,983.15) -721.1% Santa Cruz -- -- -- -- -- -- -- Small Counties 66 111 -45 $168,036.36 $282,606.61 ($114,570.25) -68.2% Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus 42 0 42 $82,905.39 $0.00 $82,905.39 100.0% Tulare 54 17 37 $98,005.86 $30,853.70 $67,152.16 68.5% Ventura 14 3 11 $31,504.34 $6,750.93 $24,753.41 78.6% 146 See Appendix D for County Participants 147 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 241 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.37 Full Service Partnership Services – Transition Age Youth: Inpatient Hospitalization (Physical) FY 09-10 New Enrollees Only 148 Small Counties are grouped together in the table 149 Transition Age Youth Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte 4 19 -15 $10,279.55 $48,827.85 ($38,548.30) -375.0% Contra Costa 4 3 1 $17,140.29 $12,855.22 $4,285.07 25.0% Fresno 31 24 7 $67,522.96 $52,275.84 $15,247.12 22.6% Kern 288 20 268 $635,198.40 $44,111.00 $591,087.40 93.1% Los Angeles 547 223 324 $1,322,646.00 $539,214.00 $783,432.00 59.2% Merced -- -- -- -- -- -- -- Orange 26 24 2 $72,545.72 $66,965.28 $5,580.44 7.7% Placer 3 6 -3 $10,219.35 $20,438.70 ($10,219.35) -100.0% San Bernardino 117 5 112 $284,036.22 $12,138.30 $271,897.92 95.7% San Diego 374 175 199 $992,888.98 $464,587.09 $528,301.89 53.2% San Francisco 21 22 -1 $81,140.48 $85,004.31 ($3,863.83) -4.8% San Joaquin 25 102 -77 $64,910.50 $264,834.84 ($199,924.34) -308.0% San Luis Obispo 16 1 15 $45,150.83 $2,821.93 $42,328.90 93.7% Santa Clara 25 25 0 $118,293.25 $118,293.25 $0.00 0.0% Santa Cruz** -- -- -- -- -- -- -- Small Counties 223 50 173 $596,827.34 $133,817.79 $463,009.55 77.6% Solano 105 0 105 $414,531.69 $0.00 $414,531.69 100.0% Sonoma 44 21 23 $146,550.80 $69,944.70 $76,606.10 52.3% Stanislaus 128 41 87 $272,934.15 $87,424.22 $185,509.93 68.0% Tulare 3 0 3 $5,428.25 $0.00 $5,428.25 100.0% Ventura 129 70 59 $302,323.11 $164,051.30 $138,271.81 45.7% **No new enrollees in FY 09-10 148 See Appendix D for County Participants 149 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 242 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.38 Full Service Partnership Services – Adults: Inpatient Hospitalization (Physical) FY 08-09 New Enrollees Only 150 Small Counties are grouped together in the table 151 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County Pre FSP Post FSP Days Butte 30 3 27 $70,971.37 $7,097.14 $63,874.23 90.0% Contra Costa 7 47 -40 $27,584.31 $185,208.96 ($157,624.65) -571.4% Fresno 254 146 108 $524,383.00 $301,417.00 $222,966.00 42.5% Kern 65 1 64 $132,642.90 $2,040.66 $130,602.24 98.5% Los Angeles 2,479 3,012 -533 $5,461,237.00 $6,635,436.00 ($1,174,199.00) -21.5% Merced 30 2 28 $67,047.61 $4,469.84 $62,577.77 93.3% Orange 213 280 -67 $562,878.06 $739,933.60 ($177,055.54) -31.5% Placer 10 41 -31 $32,576.50 $133,563.65 ($100,987.15) -310.0% San Bernardino 658 772 -114 $1,520,012.90 $1,783,358.60 ($263,345.70) -17.3% San Diego 312 177 135 $756,569.48 $429,207.69 $327,361.79 43.3% San Francisco 381 599 -218 $1,373,139.97 $2,158,821.11 ($785,681.14) -57.2% San Joaquin 342 209 133 $855,930.24 $523,068.48 $332,861.76 38.9% San Luis Obispo 33 43 -10 $86,911.80 $113,248.71 ($26,336.91) -30.3% Santa Clara 401 28 373 $1,712,249.95 $119,558.60 $1,592,691.35 93.0% Santa Cruz 24 0 24 $73,798.73 $0.00 $73,798.73 100.0% Small Counties 260 228 32 $661,961.43 $580,489.25 $81,472.18 12.3% Solano 33 19 14 $120,713.73 $69,501.84 $51,211.89 42.4% Sonoma 24 75 -51 $68,137.92 $212,931.00 ($144,793.08) -212.5% Stanislaus 169 86 83 $333,595.52 $169,758.67 $163,836.85 49.1% Tulare 114 26 88 $206,901.26 $47,188.01 $159,713.25 77.2% Ventura 41 18 23 $92,262.71 $40,505.58 $51,757.13 56.1% 150 See Appendix D for County Participants 151 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 243 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.39 Full Service Partnership Services – Adults: Inpatient Hospitalization (Physical) FY 09-10 New Enrollees Only 152 Small Counties are grouped together in the table 153 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte 19 0 19 $48,827.85 $0.00 $48,827.85 100.0% Contra Costa 2 0 2 $8,570.15 $0.00 $8,570.15 100.0% Fresno 251 20 231 $546,718.16 $43,563.20 $503,154.96 92.0% Kern 88 4 84 $194,088.40 $8,822.20 $185,266.20 95.5% Los Angeles 2,450 2,079 371 $5,924,100.00 $5,027,022.00 $897,078.00 15.1% Merced 9 19 -10 $21,916.69 $46,268.56 ($24,351.87) -111.1% Orange 235 248 -13 $655,701.70 $691,974.56 ($36,272.86) -5.5% Placer 40 46 -6 $136,258.00 $156,696.70 ($20,438.70) -15.0% San Bernardino 338 468 -130 $820,549.08 $1,136,144.88 ($315,595.80) -38.5% San Diego 1,029 916 113 $2,731,772.08 $2,431,781.56 $299,990.52 11.0% San Francisco 198 359 -161 $765,038.82 $1,387,115.84 ($622,077.02) -81.3% San Joaquin 334 359 -25 $867,204.28 $932,114.78 ($64,910.50) -7.5% San Luis Obispo 8 2 6 $22,575.41 $5,643.85 $16,931.56 75.0% Santa Clara 498 644 -146 $2,356,401.54 $3,047,234.12 ($690,832.58) -29.3% Santa Cruz** -- -- -- -- -- -- -- Small Counties 343 287 56 $917,990.04 $768,114.11 $149,875.93 16.3% Solano 155 68 87 $611,927.74 $268,458.62 $343,469.12 56.1% Sonoma 9 0 9 $29,976.30 $0.00 $29,976.30 100.0% Stanislaus 57 55 2 $121,540.99 $117,276.39 $4,264.60 3.5% Tulare 1,486 0 1,486 $2,688,795.56 $0.00 $2,688,795.56 100.0% Ventura 214 101 113 $501,528.26 $236,702.59 $264,825.67 52.8% **No new enrollees in FY 09-10 152 See Appendix D for County Participants 153 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 244 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.40 Full Service Partnership Services – Older Adults: Inpatient Hospitalization (Physical) FY 08-09 New Enrollees Only 154 Small Counties are grouped together in the table 155 Older Adults Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year Post Year Pre FSP Days County FSP Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern 13 26 -13 $26,528.58 $53,057.16 ($26,528.58) -100.0% Los Angeles 909 756 153 $2,002,527.00 $1,665,468.00 $337,059.00 16.8% Merced 0 1 -1 $0.00 $2,234.92 ($2,234.92) 0.0% Orange 3 93 -90 $7,927.86 $245,763.66 ($237,835.80) -3,000.0% Placer 34 5 29 $110,760.10 $16,288.25 $94,471.85 85.3% San Bernardino 86 158 -72 $198,664.30 $364,987.90 ($166,323.60) -83.7% San Diego 48 86 -38 $116,395.31 $208,541.59 ($92,146.28) -79.2% San Francisco 199 88 111 $717,204.34 $317,155.69 $400,048.65 55.8% San Joaquin 164 121 43 $410,446.08 $302,829.12 $107,616.96 26.2% San Luis Obispo 50 13 37 $131,684.55 $34,237.98 $97,446.57 74.0% Santa Clara 63 38 25 $269,006.85 $162,258.10 $106,748.75 39.7% Santa Cruz -- -- -- -- -- -- -- Small Counties 19 12 7 $48,374.10 $30,552.07 $17,822.03 36.8% Solano 92 50 42 $336,535.24 $182,899.59 $153,635.65 45.7% Sonoma -- -- -- -- -- -- -- Stanislaus 45 32 13 $88,827.21 $63,166.02 $25,661.19 28.9% Tulare -- -- -- -- -- -- -- Ventura 172 217 -45 $387,053.32 $488,317.27 ($101,263.95) -26.2% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 154 See Appendix D for County Participants 155 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra County did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claimed expenditures for Older Adults in the study, and is therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 245 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.41 Full Service Partnership Services – Older Adults: Inpatient Hospitalization (Physical) FY 09-10 New Enrollees Only 156 Small Counties are grouped together in the table 157 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County – Pre FSP – Post FSP Days Butte 86 27 59 $221,010.25 $69,386.94 $151,623.31 68.6% Contra Costa* -- -- -- -- -- -- -- Fresno 30 0 30 $65,344.80 $0.00 $65,344.80 100.0% Kern 19 47 -28 $41,905.45 $103,660.85 ($61,755.40) -147.4% Los Angeles 77 375 -298 $186,186.00 $906,750.00 ($720,564.00) -387.0% Merced -- -- -- -- -- -- -- Orange 12 158 -146 $33,482.64 $440,854.76 ($407,372.12) -1216.7% Placer -- -- -- -- -- -- -- San Bernardino 39 6 33 $94,678.74 $14,565.96 $80,112.78 84.6% San Diego 145 105 40 $384,943.59 $278,752.25 $106,191.34 27.6% San Francisco 35 89 -54 $135,234.14 $343,881.09 ($208,646.95) -154.3% San Joaquin 279 341 -62 $724,401.18 $885,379.22 ($160,978.04) -22.2% San Luis Obispo 17 15 2 $47,972.76 $42,328.90 $5,643.86 11.8% Santa Clara 17 42 -25 $80,439.41 $198,732.66 ($118,293.25) -147.1% Santa Cruz** -- -- -- -- -- -- -- Small Counties 68 198 -130 $181,992.19 $529,918.45 ($347,926.26) -191.2% Solano 11 0 11 $43,427.13 $0.00 $43,427.13 100.0% Sonoma 207 101 106 $689,454.90 $336,400.70 $353,054.20 51.2% Stanislaus 26 78 -52 $55,439.75 $166,319.25 ($110,879.50) -200.0% Tulare 54 0 54 $97,708.59 $0.00 $97,708.59 100.0% Ventura 109 23 86 $255,451.31 $53,902.57 $201,548.74 78.9% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study **No new enrollees in FY 09-10 156 See Appendix D for County Participants 157 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Napa, San Benito, Shasta, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra, Colusa, Del Norte, and Mono counties did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 246 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.42 Full Service Partnership Services – Children, Youth and Families: Inpatient Skilled Nursing (Non-Psychiatric) FY 08-09 New Enrollees Only 158 Small Counties are grouped together in the table 159 Children, Youth, and Families Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Days County FSP FSP Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz* -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 158 See Appendix D for County Participants 159 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 247 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.43 Full Service Partnership Services – Children, Youth and Families: Inpatient Skilled Nursing (Non-Psychiatric) FY 09-10 New Enrollees Only 160 Small Counties are grouped together in the table 161 Children, Youth, and Families Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent – Pre FSP – Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz* -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 160 See Appendix D for County Participants 161 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Lake, Lassen, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Humboldt, Inyo, Mono and Tehama counties did not provide FSP services in FY 08-09/FY 09-10 to CYF, nor claim expenditures for CYF in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 248 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.44 Full Service Partnership Services – Transition Age Youth: Inpatient Skilled Nursing (Non-Psychiatric) FY 08-09 New Enrollees Only 162 Small Counties are grouped together in the table 163 Transition Age Youth Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year Pre FSP Year Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa 14 0 14 $1,503.34 $0.00 $1,503.34 100.0% Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego 0 2 -2 $0.00 $178.62 ($178.62) 0.0% San Francisco 0 34 -34 $0.00 $3,844.72 ($3,844.72) 0.0% San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- 162 See Appendix D for County Participants 163 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 249 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.45 Full Service Partnership Services – Transition Age Youth: Inpatient Skilled Nursing (Non-Psychiatric) FY 09-10 New Enrollees Only 164 Small Counties are grouped together in the table 165 Transition Age Youth Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo 10 0 10 $778.20 $0.00 $778.20 100.0% Santa Clara -- -- -- -- -- -- -- Santa Cruz** -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- **No new enrollees in FY 09-10 164 See Appendix D for County Participants 165 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 250 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.46 Full Service Partnership Services – Adults: Inpatient Skilled Nursing (Non-Psychiatric) FY 08-09 New Enrollees Only 166 Small Counties are grouped together in the table 167 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa 0 19 -19 $0.00 $2,040.25 ($2,040.25) -100.0% Fresno 91 76 15 $7,131.63 $5,956.09 $1,175.54 16.5% Kern -- -- -- -- -- -- -- Los Angeles 1,559 737 822 $118,063.07 $55,813.01 $62,250.06 52.7% Merced -- -- -- -- -- -- -- Orange 0 46 -46 $0.00 $4,257.30 ($4,257.30) 0.0% Placer 0 1 -1 $0.00 $81.74 ($81.74) 0.0% San Bernardino 0 314 -314 $0.00 $725,355.70 ($725,355.70) 0.0% San Diego 0 46 -46 $0.00 $178.62 ($178.62) 0.0% San Francisco 10 73 -63 $1,130.80 $8,254.85 ($7,124.05) -630.0% San Joaquin -- -- -- -- -- -- -- San Luis Obispo 0 7 -7 $0.00 $530.11 ($530.11) 0.0% Santa Clara -- -- -- -- -- -- -- Santa Cruz -- -- -- -- -- -- -- Small Counties 0 7 -7 $0.00 $1,497.73 ($1,497.73) 0.0% Solano 41 7 34 $4,416.62 $754.06 $3,662.56 82.9% Sonoma 0 155 -155 $0.00 $16,380.40 ($16,380.40) 0.0% Stanislaus 30 29 1 $2,640.58 $2,552.56 $88.02 3.3% Tulare -- -- -- -- -- -- -- Ventura 300 4 296 $27,366.00 $364.88 $27,001.12 98.7% 166 See Appendix D for County Participants 167 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 251 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.47 Full Service Partnership Services – Adults: Inpatient Skilled Nursing (Non-Psychiatric) FY 09-10 New Enrollees Only 168 Small Counties are grouped together in the table 169 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte 7 0 7 $596.47 $0.00 $596.47 100.0% Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles 535 237 298 $41,633.70 $18,443.34 $23,190.36 55.7% Merced -- -- -- -- -- -- -- Orange 185 186 -1 $44,612.75 $44,853.90 ($241.15) -0.5% Placer 0 135 -135 $0.00 $14,203.35 ($14,203.35) 0.0% San Bernardino 74 59 15 $179,646.84 $143,231.94 $36,414.90 20.3% San Diego 687 670 17 $62,808.28 $61,254.07 $1,554.21 2.5% San Francisco -- -- -- -- -- -- -- San Joaquin 263 85 178 $24,782.49 $8,009.55 $16,772.94 67.7% San Luis Obispo -- -- -- -- -- -- -- Santa Clara $0.00 24 -24 $0.00 $2,571.60 ($2,571.60) 0.0% Santa Cruz** -- -- -- -- -- -- -- Small Counties 510 337 173 $117,743.16 $77,802.84 $39,940.32 33.9% Solano 17 0 17 $1,841.15 $0.00 $1,841.15 100.0% Sonoma 22 0 22 $2,397.56 $0.00 $2,397.56 100.0% Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura 193 29 164 $36,820.54 $5,532.62 $31,287.92 85.0% **No new enrollees in FY 09-10 168 See Appendix D for County Participants 169 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 252 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.48 Full Service Partnership Services – Older Adults: Inpatient Skilled Nursing (Non-Psychiatric) FY 08-09 New Enrollees Only 170 Small Counties are grouped together in the table 171 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern 361 3 358 $29,039.67 $241.33 $28,798.34 99.2% Los Angeles 664 389 275 $50,284.72 $29,458.97 $20,825.75 41.4% Merced -- -- -- -- -- -- -- Orange 0 210 -210 $0.00 $19,435.50 ($19,435.50) 0.0% Placer 239 35 204 $24,421.02 $3,576.30 $20,844.72 85.4% San Bernardino 0 28 -28 $0.00 $64,681.40 ($64,681.40) 0.0% San Diego 195 48 147 $17,415.91 $4,286.99 $13,128.92 75.4% San Francisco 1 6 -5 $113.08 $678.48 ($565.40) -500.0% San Joaquin 460 202 258 $41,354.00 $18,159.80 $23,194.20 56.1% San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz -- -- -- -- -- -- -- Small Counties 298 61 237 $63,760.57 $13,051.66 $50,708.91 79.5% Solano 77 28 49 $8,294.62 $3,016.23 $5,278.39 63.6% Sonoma -- -- -- -- -- -- -- Stanislaus 15 0 15 $1,320.29 $0.00 $1,320.29 100.0% Tulare -- -- -- -- -- -- -- Ventura 865 38 827 $78,905.30 $3,466.36 $75,438.94 95.6% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 170 See Appendix D for County Participants 171 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra County did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 253 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.49 Full Service Partnership Services – Older Adults: Inpatient Skilled Nursing (Non-Psychiatric) FY 09-10 New Enrollees Only 172 Small Counties are grouped together in the table 173 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County – Pre FSP – Post FSP Days Butte 691 121 570 $58,879.97 $10,310.39 $48,569.58 82.5% Contra Costa* -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles 152 197 -45 $11,828.64 $15,330.54 ($3,501.90) -29.6% Merced -- -- -- -- -- -- -- Orange 90 72 18 $21,703.50 $17,362.80 $4,340.70 20.0% Placer -- -- -- -- -- -- -- San Bernardino 21 76 -55 $50,980.86 $184,502.16 ($133,521.30) -261.9% San Diego 323 121 202 $29,529.95 $11,062.30 $18,467.65 62.5% San Francisco -- -- -- -- -- -- -- San Joaquin 90 178 -88 $8,480.70 $16,772.94 ($8,292.24) -97.8% San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz** -- -- -- -- -- -- -- Small Counties 116 136 -20 $26,780.80 $31,398.18 ($4,617.38) -17.2% Solano 162 0 162 $17,545.10 $0.00 $17,545.10 100.0% Sonoma 30 42 -12 $3,269.40 $4,577.16 ($1,307.76) -40.0% Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura 26 25 1 $4,960.28 $4,769.50 $190.78 3.8% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study **No new enrollees in FY 09-10 172 See Appendix D for County Participants 173 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Napa, San Benito, Shasta, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra, Colusa, Del Norte, and Mono counties did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 254 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.50 Full Service Partnership Services – Children, Youth and Families: Emergency Room Use FY 08-09 New Enrollees Only 174 Small Counties are grouped together in the table 175 Children, Youth, and Families Number of Number of Decrease in ER Visits Per ER Visits Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post ER Visits County FSP FSP Butte 2 0 2 $372.33 $0.00 $372.33 100.0% Contra Costa 5 1 4 $1,358.31 $271.66 $1,086.65 80.0% Fresno 1 0 1 $271.53 $0.00 $271.53 100.0% Kern -- -- -- -- -- -- -- Los Angeles 129 14 115 $25,267.14 $2,742.17 $22,524.97 89.1% Merced 6 0 6 $927.63 $0.00 $927.63 100.0% Orange 52 6 46 $9,372.28 $1,081.42 $8,290.86 88.5% Placer 4 0 4 $750.42 $0.00 $750.42 100.0% San Bernardino 88 10 78 $14,622.36 $1,661.63 $12,960.73 88.6% San Diego 18 3 15 $4,497.38 $749.56 $3,747.82 83.3% San Francisco 5 1 4 $1,537.19 $307.44 $1,229.75 80.0% San Joaquin 2 0 2 $370.42 $0.00 $370.42 100.0% San Luis Obispo 10 0 10 $1,542.66 $0.00 $1,542.66 100.0% Santa Clara 9 0 9 $2,903.19 $0.00 $2,903.19 100.0% Santa Cruz* -- -- -- -- -- -- -- Small Counties 39 0 39 $8,037.11 $0.00 $8,037.11 100.0% Solano 1 0 1 $233.27 $0.00 $233.27 100.0% Sonoma 2 0 2 $489.48 $73.42 $416.06 85.0% Stanislaus 3 0 3 $540.75 $0.00 $540.75 100.0% Tulare -- -- -- -- -- -- -- Ventura 1 0 1 $180.24 $0.00 $180.24 100.0% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 174 See Appendix D for County Participants 175 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 255 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.51 Full Service Partnership Services – Children, Youth and Families: Emergency Room Use FY 09-10 New Enrollees Only 176 Small Counties are grouped together in the table 177 Children, Youth, and Families Number of ER Number of ER Decrease in Visits Per Visits Per Number of ER Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Visits County FSP FSP Butte -- -- -- -- -- -- -- Contra Costa 4 4 0 $1,144.90 $1,144.90 $0.00 0.0% Fresno 32 2 30 $8,119.61 $507.48 $7,612.13 93.7% Kern 2 0 2 $410.68 $0.00 $410.68 100.0% Los Angeles 140 6 134 $29,026.93 $1,244.01 $27,782.92 95.7% Merced 6 2 4 $1,031.95 $343.98 $687.97 66.7% Orange 31 2 29 $5,365.69 $346.17 $5,019.52 93.5% Placer -- -- -- -- -- -- -- San Bernardino 174 10 164 $29,094.85 $1,672.12 $27,422.73 94.3% San Diego 158 9 149 $41,648.89 $2,372.40 $39,276.49 94.3% San Francisco 16 4 12 $5,248.89 $1,312.22 $3,936.67 75.0% San Joaquin 14 0 14 $2,547.44 $0.00 $2,547.44 100.0% San Luis Obispo 12 6 6 $2,313.38 $1,156.69 $1,156.69 50.0% Santa Clara 3 0 3 $981.47 $0.00 $981.47 100.0% Santa Cruz* -- -- -- -- -- -- -- Small Counties 44 2 42 $9,345.71 $424.81 $8,920.90 95.5% Solano 7 1 6 $1,576.85 $225.26 $1,351.59 85.7% Sonoma 1 0 1 $257.07 $0.00 $257.07 100.0% Stanislaus 1 0 1 $220.03 $0.00 $220.03 100.0% Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 176 See Appendix D for County Participants 177 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Lake, Lassen, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Humboldt, Inyo, Mono and Tehama counties did not provide FSP services in FY 08-09/FY 09-10 to CYF, nor claim expenditures for CYF in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 256 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.52 Full Service Partnership Services – Transition Age Youth: Emergency Room Use FY 08-09 New Enrollees Only 178 Small Counties are grouped together in the table 179 Transition Age Youth Number of Number of Decrease in ER Visits Per ER Visits Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post ER Visits County FSP FSP Butte 5 1 4 $930.81 $186.16 $744.65 80.0% Contra Costa 10 5 5 $2,716.62 $1,358.31 $1,358.31 50.0% Fresno 48 3 45 $13,033.53 $814.60 $12,218.93 93.7% Kern 48 1 47 $10,157.83 $211.62 $9,946.21 97.9% Los Angeles 88 3 85 $17,236.50 $587.61 $16,648.89 96.6% Merced 6 10 -4 $927.63 $1,546.06 ($618.43) -66.7% Orange 97 6 91 $17,482.91 $1,081.42 $16,401.49 93.8% Placer 5 3 2 $938.02 $562.81 $375.21 40.0% San Bernardino 263 12 251 $43,700.92 $1,993.96 $41,706.96 95.4% San Diego 80 5 75 $19,988.34 $1,249.27 $18,739.07 93.8% San Francisco 15 1 14 $4,611.56 $307.44 $4,304.12 93.3% San Joaquin 39 6 33 $7,223.12 $1,111.25 $6,111.87 84.6% San Luis Obispo 4 4 0 $617.06 $617.06 $0.00 0.0% Santa Clara 26 4 22 $8,387.00 $1,290.31 $7,096.69 84.6% Santa Cruz -- -- -- -- -- -- -- Small Counties 212 33 179 $43,688.89 $6,800.63 $36,888.26 84.4% Solano 4 0 4 $933.10 $0.00 $933.10 100.0% Sonoma 8 0 8 $1,957.90 $0.00 $1,957.90 100.0% Stanislaus 41 0 41 $7,390.27 $0.00 $7,390.27 100.0% Tulare 55 0 55 $7,043.34 $0.00 $7,043.34 100.0% Ventura 54 6 48 $9,732.76 $1,081.42 $8,651.34 88.9% 178 See Appendix D for County Participants 179 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 257 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.53 Full Service Partnership Services – Transition Age Youth: Emergency Room Use FY 09-10 New Enrollees Only 180 Small Counties are grouped together in the table 181 Transition Age Youth Number of ER Number of ER Decrease in Visits Per Visits Per Number of ER Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Visits County FSP FSP Butte 21 2 19 $4,098.87 $390.37 $3,708.50 90.5% Contra Costa 38 10 28 $10,876.56 $2,862.25 $8,014.31 73.7% Fresno 24 2 22 $6,089.71 $507.48 $5,582.23 91.7% Kern 51 1 50 $10,472.36 $205.34 $10,267.02 98.0% Los Angeles 138 9 129 $28,612.26 $1,866.02 $26,746.24 93.5% Merced 15 1 14 $2,579.87 $171.99 $2,407.88 93.3% Orange 48 4 44 $8,308.16 $692.35 $7,615.81 91.7% Placer 2 0 2 $391.19 $0.00 $391.19 100.0% San Bernardino 218 7 211 $36,452.16 $1,170.48 $35,281.68 96.8% San Diego 135 6 129 $35,586.07 $1,581.60 $34,004.47 95.6% San Francisco 9 4 5 $2,952.50 $1,312.22 $1,640.28 55.6% San Joaquin 110 7 103 $20,015.61 $1,273.72 $18,741.89 93.6% San Luis Obispo 19 7 12 $3,662.86 $1,349.47 $2,313.39 63.2% Santa Clara 13 2 11 $4,253.03 $654.31 $3,598.72 84.6% Santa Cruz** -- -- -- -- -- -- -- Small Counties 89 17 72 $18,903.83 $3,610.84 $15,292.99 80.9% Solano 5 0 5 $1,126.32 $0.00 $1,126.32 100.0% Sonoma 17 0 17 $4,370.14 $0.00 $4,370.14 100.0% Stanislaus 20 11 9 $4,400.64 $2,420.35 $1,980.29 45.0% Tulare 8 5 3 $971.35 $607.09 $364.26 37.5% Ventura 182 8 174 $32,285.89 $1,419.16 $30,866.73 95.6% **No new enrollees in FY 09-10 180 See Appendix D for County Participants 181 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 258 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.54 Full Service Partnership Services – Adults: Emergency Room Use FY 08-09 New Enrollees Only 182 Small Counties are grouped together in the table 183 Adults Number of ER Number of ER Decrease in Visits Per Visits Per Number of ER Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Visits County FSP FSP Butte 22 1 21 $4,095.58 $186.16 $3,909.42 95.5% Contra Costa 26 3 23 $7,063.21 $814.99 $6,248.22 88.5% Fresno 202 3 199 $54,849.42 $814.60 $54,034.82 98.5% Kern 130 1 129 $27,510.79 $211.62 $27,299.17 99.2% Los Angeles 721 52 669 $141,221.78 $10,185.20 $131,036.58 92.8% Merced 29 8 21 $4,483.57 $1,236.85 $3,246.72 72.4% Orange 240 15 225 $43,256.69 $2,703.54 $40,553.15 93.8% Placer 16 2 14 $3,001.67 $375.21 $2,626.46 87.5% San Bernardino 597 61 536 $99,199.42 $10,135.95 $89,063.47 89.8% San Diego 112 28 84 $27,983.67 $6,995.92 $20,987.75 75.0% San Francisco 293 19 274 $90,079.05 $5,841.30 $84,237.75 93.5% San Joaquin 343 6 337 $63,526.38 $1,111.25 $62,415.13 98.3% San Luis Obispo 35 8 27 $5,399.30 $1,234.13 $4,165.17 77.1% Santa Clara 69 4 65 $22,257.80 $1,290.31 $20,967.49 94.2% Santa Cruz 9 3 6 $1,986.04 $662.01 $1,324.03 66.7% Small Counties 270 47 223 $55,641.51 $9,685.75 $45,955.76 82.6% Solano 12 5 7 $2,799.29 $1,166.37 $1,632.92 58.3% Sonoma 10 2 8 $2,447.38 $489.48 $1,957.90 80.0% Stanislaus 252 16 236 $45,423.13 $2,884.01 $42,539.12 93.7% Tulare 215 3 212 $27,533.07 $384.18 $27,148.89 98.6% Ventura 25 32 -7 $4,505.91 $5,767.56 ($1,261.65) -28.0% 182 See Appendix D for County Participants 183 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 259 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.55 Full Service Partnership Services – Adults: Emergency Room Use FY 09-10 New Enrollees Only 184 Small Counties are grouped together in the table 185 Adults Number of ER Number of ER Decrease in Visits Per Visits Per Number of ER Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Visits County FSP FSP Butte 61 0 61 $11,906.24 $0.00 $11,906.24 100.0% Contra Costa 18 3 15 $5,152.06 $858.68 $4,293.38 83.3% Fresno 202 3 199 $51,255.06 $761.21 $50,493.85 98.5% Kern 82 1 81 $16,837.91 $205.34 $16,632.57 98.8% Los Angeles 336 29 307 $69,664.64 $6,012.72 $63,651.92 91.4% Merced 3 5 -2 $515.97 $859.96 ($343.99) -66.7% Orange 117 35 82 $20,251.14 $6,058.03 $14,193.11 70.1% Placer 25 0 25 $4,889.85 $0.00 $4,889.85 100.0% San Bernardino 261 54 207 $43,642.27 $9,029.43 $34,612.84 79.3% San Diego 239 532 -293 $63,000.53 $140,235.49 -$77,234.96 -122.6% San Francisco 76 31 45 $24,932.24 $10,169.73 $14,762.51 59.2% San Joaquin 459 14 445 $83,519.68 $2,547.44 $80,972.24 96.9% San Luis Obispo 40 11 29 $7,711.28 $2,120.60 $5,590.68 72.5% Santa Clara 73 7 66 $23,882.39 $2,290.09 $21,592.30 90.4% Santa Cruz** -- -- -- -- -- -- -- Small Counties 539 42 497 $114,485.00 $8,920.91 $105,564.09 92.2% Solano 15 8 7 $3,378.96 $1,802.11 $1,576.85 46.7% Sonoma 20 2 18 $5,141.34 $514.13 $4,627.21 90.0% Stanislaus 131 8 123 $28,824.22 $1,760.26 $27,063.96 93.9% Tulare 19 4 15 $2,306.96 $485.68 $1,821.28 78.9% Ventura 190 52 138 $33,705.05 $9,224.54 $24,480.51 72.6% **No new enrollees in FY 09-10 184 See Appendix D for County Participants 185 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 260 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.56 Full Service Partnership Services – Older Adults: Emergency Room Use FY 08-09 New Enrollees Only 186 Small Counties are grouped together in the table 187 Older Adults Number of ER Number of ER Decrease in Visits Per Visits Per Number of ER Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Visits County FSP FSP Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno 7 0 7 $1,900.72 $0.00 $1,900.72 100.0% Kern 107 3 104 $22,643.50 $634.86 $22,008.64 97.2% Los Angeles 151 6 145 $ 29,576.27 $1,175.22 $28,401.05 96.0% Merced 0 7 -7 $0.00 $1,082.24 ($1,082.24) 0.0% Orange 20 3 17 $3,604.72 $540.71 $3,064.01 85.0% Placer 6 1 5 $1,125.63 $187.60 $938.03 83.3% San Bernardino 18 1 17 $2,990.94 $166.16 $2,824.78 94.4% San Diego 83 17 66 $20,737.90 $4,247.52 $16,490.38 79.5% San Francisco 126 2 124 $38,737.07 $614.87 $38,122.20 98.4% San Joaquin 70 12 58 $12,964.57 $2,222.50 $10,742.07 82.9% San Luis Obispo 12 7 5 $1,851.19 $1,079.86 $771.33 41.7% Santa Clara 2 0 2 $645.15 $0.00 $645.15 100.0% Santa Cruz 3 0 3 $662.01 $0.00 $662.01 100.0% Small Counties 66 8 58 $13,601.26 $1,648.64 $11,952.62 87.9% Solano 36 11 25 $8,397.87 $2,566.01 $5,831.86 69.4% Sonoma 1 0 1 $244.74 $0.00 $244.74 100.0% Stanislaus 15 3 12 $2,703.76 $540.75 $2,163.01 80.0% Tulare -- -- -- -- -- -- -- Ventura 44 64 -20 $7,930.39 $11,535.12 ($3,604.73) -45.5% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 186 See Appendix D for County Participants 187 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra County did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 261 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.57 Full Service Partnership Services – Older Adults: Emergency Room Use FY 09-10 New Enrollees Only 188 Small Counties are grouped together in the table 189 Older Adults Number of ER Number of ER Decrease in Visits Per Year Visits Per Year Number of ER Pre FSP Cost Post FSP Cost Total Offset Percent County – Pre FSP – Post FSP Visits Butte 52 0 52 $10,149.58 $0.00 $10,149.58 100.0% Contra Costa* -- -- -- -- -- -- -- Fresno 3 0 3 $761.21 $0.00 $761.21 100.0% Kern 13 3 10 $2,669.42 $616.02 $2,053.40 76.9% Los Angeles 47 11 36 $9,744.76 $2,280.69 $7,464.07 76.6% Merced -- -- -- -- -- -- -- Orange 15 6 9 $2,596.30 $1,038.52 $1,557.78 60.0% Placer -- -- -- -- -- -- -- San Bernardino 18 3 15 $3,009.81 $501.64 $2,508.17 83.3% San Diego 76 12 64 $20,033.64 $3,163.21 $16,870.43 84.2% San Francisco 31 5 26 $10,169.73 $1,640.28 $8,529.45 83.9% San Joaquin 73 32 41 $13,283.09 $5,822.72 $7,460.37 56.2% San Luis Obispo 7 14 -7 $1,349.47 $2,698.95 ($1,349.48) -100.0% Santa Clara 3 0 3 $981.47 $0.00 $981.47 100.0% Santa Cruz** -- -- -- -- -- -- -- Small Counties 55 15 40 $11,682.14 $3,186.04 $8,496.10 72.7% Solano 4 15 -11 $901.06 $3,378.96 ($2,477.90) -275.0% Sonoma 51 7 44 $13,110.41 $1,799.47 $11,310.94 86.3% Stanislaus 12 4 8 $2,640.39 $880.13 $1,760.26 66.7% Tulare 1 1 0 $121.42 $84.99 $36.43 30.0% Ventura 28 32 -4 $4,967.06 $5,676.64 ($709.58) -14.3% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study **No new enrollees in FY 09-10 188 See Appendix D for County Participants 189 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Napa, San Benito, Shasta, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra, Colusa, Del Norte, and Mono counties did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 262 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.58 Full Service Partnership Services – Children, Youth and Families: Division of Juvenile Justice FY 08-09 New Enrollees Only 190 Small Counties are grouped together in the table 191 Children, Youth, and Families Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Days County FSP FSP Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles 415 42 373 $266,089.70 $26,929.56 $239,160.14 89.9% Merced -- -- -- -- -- -- -- Orange 4 0 4 $2,564.72 $0.00 $2,564.72 100.0% Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco 0 12 -12 $0.00 $7,694.16 ($7,694.16) 0.0% San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz* -- -- -- -- -- -- -- Small Counties 335 10 325 $214,795.30 $6,411.80 $208,383.50 97.0% Solano 0 62 -62 $0.00 $39,753.16 ($39,753.16) 0.0% Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura 3 0 3 $1,923.54 $0.00 $1,923.54 100.0% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 190 See Appendix D for County Participants 191 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 263 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.59 Full Service Partnership Services – Children, Youth and Families: Division of Juvenile Justice FY 09-10 New Enrollees Only 192 Small Counties are grouped together in the table 193 Children, Youth, and Families Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent – Pre FSP – Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced 3 0 3 $704.07 $0.00 $704.07 100.0% Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino 70 20 50 $46,027.10 $13,150.60 $32,876.50 71.4% San Diego 157 0 157 $103,232.21 $0.00 $103,232.21 100.0% San Francisco 40 0 40 $26,301.20 $0.00 $26,301.20 100.0% San Joaquin 12 0 12 $7,890.36 $0.00 $7,890.36 100.0% San Luis Obispo -- -- -- -- -- -- -- Santa Clara 270 0 270 $177,533.10 $0.00 $177,533.10 100.0% Santa Cruz* -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus 1 0 1 $657.53 $0.00 $657.53 100.0% Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 192 See Appendix D for County Participants 193 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Lake, Lassen, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Humboldt, Inyo, Mono and Tehama counties did not provide FSP services in FY 08-09/FY 09-10 to CYF, nor claim expenditures for CYF in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 264 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.60 Full Service Partnership Services – Transition Age Youth: Division of Juvenile Justice FY 08-09 New Enrollees Only 194 Small Counties are grouped together in the table 195 Transition Age Youth Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year Pre FSP Year Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno 365 0 365 $234,030.70 $0.00 $234,030.70 100.0% Kern -- -- -- -- -- -- -- Los Angeles 1,268 0 1,268 $813,016.24 $0.00 $813,016.24 100.0% Merced -- -- -- -- -- -- -- Orange 361 2 359 $231,465.98 $1,282.36 $230,183.62 99.4% Placer -- -- -- -- -- -- -- San Bernardino 31 0 31 $19,876.58 $0.00 $19,876.58 100.0% San Diego 11 25 -14 $7,052.98 $16,029.50 ($8,976.52) -127.3% San Francisco 151 0 151 $96,818.18 $0.00 $96,818.18 100.0% San Joaquin 8 0 8 $5,129.44 $0.00 $5,129.44 100.0% San Luis Obispo -- -- -- -- -- -- -- Santa Clara 240 0 240 $153,883.20 $0.00 $153,883.20 100.0% Santa Cruz -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare 180 79 101 $115,412.40 $50,653.22 $64,759.18 56.1% Ventura -- -- -- -- -- -- -- 194 See Appendix D for County Participants 195 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 265 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.61 Full Service Partnership Services – Transition Age Youth: Division of Juvenile Justice FY 09-10 New Enrollees Only 196 Small Counties are grouped together in the table 197 Transition Age Youth Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern 4 0 4 $2,630.12 $0.00 $2,630.12 100.0% Los Angeles 956 0 956 $628,598.68 $0.00 $628,598.68 100.0% Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino 461 20 441 $303,121.33 $13,150.60 $289,970.73 95.7% San Diego 40 0 40 $26,301.20 $0.00 $26,301.20 100.0% San Francisco 1 2 -1 $657.53 $1,315.06 ($657.53) -100.0% San Joaquin 240 0 240 $157,807.20 $0.00 $157,807.20 100.0% San Luis Obispo 5 0 5 $3,287.65 $0.00 $3,287.65 100.0% Santa Clara 330 0 330 $216,984.90 $0.00 $216,984.90 100.0% Santa Cruz** -- -- -- -- -- -- -- Small Counties 199 5 194 $127,594.82 $3,205.90 $124,388.92 97.5% Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura 426 18 408 $280,107.78 $11,835.54 $268,272.24 95.8% **No new enrollees in FY 09-10 196 See Appendix D for County Participants 197 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 266 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.62 Full Service Partnership Services – Adults: Division of Juvenile Justice FY 08-09 New Enrollees Only 198 Small Counties are grouped together in the table 199 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County Pre FSP Post FSP Days Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- 198 See Appendix D for County Participants 199 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 267 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.63 Full Service Partnership Services – Adults: Division of Juvenile Justice FY 09-10 New Enrollees Only 200 Small Counties are grouped together in the table 201 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz** -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- **No new enrollees in FY 09-10 200 See Appendix D for County Participants 201 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 268 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.64 Full Service Partnership Services – Older Adults: Division of Juvenile Justice FY 08-09 New Enrollees Only 202 Small Counties are grouped together in the table 203 Older Adults Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year Post Year Pre FSP Days County FSP Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 202 See Appendix D for County Participants 203 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra County did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and is therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 269 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.65 Full Service Partnership Services – Older Adults: Division of Juvenile Justice FY 09-10 New Enrollees Only 204 Small Counties are grouped together in the table 205 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County – Pre FSP – Post FSP Days Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz** -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study **No new enrollees in FY 09-10 204 See Appendix D for County Participants 205 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Napa, San Benito, Shasta, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra, Colusa, Del Norte, and Mono counties did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 270 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.66 Full Service Partnership Services – Children, Youth and Families: Juvenile Halls and Camps FY 08-09 New Enrollees Only 206 Small Counties are grouped together in the table 207 Children, Youth, and Families Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Days County FSP FSP Butte 93 0 93 $24,690.57 $0.00 $24,690.57 100.0% Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern 60 121 -61 $11,156.40 $22,498.74 ($11,342.34) -101.7% Los Angeles 1,551 560 991 $491,760.06 $177,553.60 $314,206.46 63.9% Merced 137 142 -5 $32,152.53 $33,325.98 ($1,173.45) -3.6% Orange 1,217 128 1,089 $386,360.99 $40,636.16 $345,724.83 89.5% Placer 25 0 25 $10,959.00 $0.00 $10,959.00 100.0% San Bernardino 505 186 319 $221,886.90 $81,724.68 $140,162.22 63.2% San Diego 60 707 -647 $12,246.00 $144,298.70 ($132,052.70) -1,078.3% San Francisco 353 294 59 $156,026.00 $129,948.00 $26,078.00 16.7% San Joaquin 94 6 88 $21,158.46 $1,350.54 $19,807.92 93.6% San Luis Obispo 48 26 22 $16,138.08 $8,741.46 $7,396.62 45.8% Santa Clara 395 631 -236 $150,890.00 $241,042.00 ($90,152.00) -59.7% Santa Cruz* -- -- -- -- -- -- -- Small Counties 1,394 632 762 $413,184.77 $187,326.24 $225,858.53 54.7% Solano 22 0 22 $4,323.00 $0.00 $4,323.00 100.0% Sonoma 64 18 46 $31,488.00 $8,856.00 $22,632.00 71.9% Stanislaus 0 581 -581 $0.00 $109,663.75 ($109,663.75) 0.0% Tulare -- -- -- -- -- -- -- Ventura 696 376 320 $191,365.20 $103,381.20 $87,984.00 46.0% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 206 See Appendix D for County Participants 207 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 271 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.67 Full Service Partnership Services – Children, Youth and Families: Juvenile Halls and Camps FY 09-10 New Enrollees Only 208 Small Counties are grouped together in the table 209 Children, Youth, and Families Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent – Pre FSP – Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa 200 49 151 $48,218.00 $11,813.41 $36,404.59 75.5% Fresno 892 133 759 $286,412.28 $42,704.97 $243,707.31 85.1% Kern 0 76 -76 $0.00 $14,131.44 ($14,131.44) 0.0% Los Angeles 2,172 484 1,688 $688,654.32 $153,457.04 $535,197.28 77.7% Merced 25 212 -187 $11,734.50 $99,508.56 ($87,774.06) -748.0% Orange 0 164 -164 $0.00 $52,065.08 ($52,065.08) 0.0% Placer -- -- -- -- -- -- -- San Bernardino 3,128 900 2,228 $1,374,380.64 $395,442.00 $978,938.64 71.2% San Diego 791 515 276 $161,443.10 $105,111.50 $56,331.60 34.9% San Francisco 245 242 3 $108,290.00 $106,964.00 $1,326.00 1.2% San Joaquin 307 155 152 $69,102.63 $34,888.95 $34,213.68 49.5% San Luis Obispo 0 7 -7 $0.00 $2,353.47 ($2,353.47) 0.0% Santa Clara 1,025 955 70 $391,550.00 $364,810.00 $26,740.00 6.8% Santa Cruz* -- -- -- -- -- -- -- Small Counties 956 793 163 $279,913.61 $232,187.76 $47,725.85 17.1% Solano -- -- -- -- -- -- -- Sonoma 41 28 13 $20,172.00 $13,776.00 $6,396.00 31.7% Stanislaus 603 798 -195 $113,816.25 $150,622.50 ($36,806.25) -32.3% Tulare -- -- -- -- -- -- -- Ventura 106 125 -19 $16,151.22 $19,046.25 ($2,895.03) -17.9% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 208 See Appendix D for County Participants 209 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Lake, Lassen, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Humboldt, Inyo, Mono and Tehama counties did not provide FSP services in FY 08-09/FY 09-10 to CYF, nor claim expenditures for CYF in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 272 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.68 Full Service Partnership Services – Transition Age Youth: Juvenile Halls and Camps FY 08-09 New Enrollees Only 210 Small Counties are grouped together in the table 211 Transition Age Youth Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year Pre FSP Year Post FSP Days County Butte 97 3 94 $25,752.53 $796.47 $24,956.06 96.9% Contra Costa 126 0 126 $30,377.34 $0.00 $30,377.34 100.0% Fresno 368 0 368 $118,161.12 $0.00 $118,161.12 100.0% Kern 31 0 31 $5,764.14 $0.00 $5,764.14 100.0% Los Angeles 4,643 2 4,641 $1,472,109.58 $634.12 $1,471,475.46 100.0% Merced 81 246 -165 $19,009.89 $57,733.74 ($38,723.85) -203.7% Orange 17,030 560 16,470 $5,406,514.10 $177,783.20 $5,228,730.90 96.7% Placer -- -- -- -- -- -- -- San Bernardino 2,533 0 2,533 $1,112,949.54 $0.00 $1,112,949.54 100.0% San Diego 1,238 198 1,040 $252,675.80 $40,411.80 $212,264.00 84.0% San Francisco 1,543 382 1,161 $682,006.00 $168,844.00 $513,162.00 75.2% San Joaquin 343 106 237 $77,205.87 $23,859.54 $53,346.33 69.1% San Luis Obispo -- -- -- -- -- -- -- Santa Clara 2,084 336 1,748 $796,088.00 $128,352.00 $667,736.00 83.9% Santa Cruz -- -- -- -- -- -- -- Small Counties 1,510 790 720 $447,567.43 $234,157.80 $213,409.63 47.7% Solano 339 0 339 $66,613.50 $0.00 $66,613.50 100.0% Sonoma -- -- -- -- -- -- -- Stanislaus 661 172 489 $124,763.75 $32,465.00 $92,298.75 74.0% Tulare -- -- -- -- -- -- -- Ventura 751 110 641 $206,487.45 $30,244.50 $176,242.95 85.4% 210 See Appendix D for County Participants 211 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 273 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.69 Full Service Partnership Services – Transition Age Youth: Juvenile Halls and Camps FY 09-10 New Enrollees Only 212 Small Counties are grouped together in the table 213 Transition Age Youth Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte 50 0 50 $13,274.50 $0.00 $13,274.50 100.0% Contra Costa 789 34 755 $190,220.01 $8,197.06 $182,022.95 95.7% Fresno 1,221 33 1,188 $392,050.89 $10,595.97 $381,454.92 97.3% Kern 827 0 827 $153,772.38 $0.00 $153,772.38 100.0% Los Angeles 7,518 455 7,063 $2,383,657.08 $144,262.30 $2,239,394.78 93.9% Merced 353 0 353 $165,691.14 $0.00 $165,691.14 100.0% Orange 8,249 116 8,133 $2,618,810.03 $36,826.52 $2,581,983.51 98.6% Placer 127 0 127 $55,671.72 $0.00 $55,671.72 100.0% San Bernardino 5,706 505 5,201 $2,507,102.28 $221,886.90 $2,285,215.38 91.1% San Diego 2,211 552 1,659 $451,265.10 $112,663.20 $338,601.90 75.0% San Francisco 1,159 294 865 $512,278.00 $129,948.00 $382,330.00 74.6% San Joaquin 1,004 70 934 $225,990.36 $15,756.30 $210,234.06 93.0% San Luis Obispo 0 41 -41 $0.00 $13,784.61 ($13,784.61) 0.0% Santa Clara 2,959 248 2,711 $1,130,338.00 $94,736.00 $1,035,602.00 91.6% Santa Cruz** -- -- -- -- -- -- -- Small Counties 2,301 813 1,488 $673,725.13 $238,043.69 $435,681.44 64.7% Solano -- -- -- -- -- -- -- Sonoma 156 0 156 $76,752.00 $0.00 $76,752.00 100.0% Stanislaus 351 202 149 $66,251.25 $38,127.50 $28,123.75 42.5% Tulare 461 0 461 $106,564.76 $0.00 $106,564.76 100.0% Ventura 2,630 609 2,021 $400,733.10 $92,793.33 $307,939.77 76.8% **No new enrollees in FY 09-10 212 See Appendix D for County Participants 213 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 274 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.70 Full Service Partnership Services – Adults: Juvenile Halls and Camps FY 08-09 New Enrollees Only 214 Small Counties are grouped together in the table 215 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- 214 See Appendix D for County Participants 215 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 275 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.71 Full Service Partnership Services – Adults: Juvenile Halls and Camps FY 09-10 New Enrollees Only 216 Small Counties are grouped together in the table 217 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz** -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- **No new enrollees in FY 09-10 216 See Appendix D for County Participants 217 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 276 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.72 Full Service Partnership Services – Older Adults: Juvenile Halls and Camps FY 08-09 New Enrollees Only 218 Small Counties are grouped together in the table 219 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 218 See Appendix D for County Participants 219 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra County did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claimed expenditures for Older Adults in the study, and is therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 277 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.73 Full Service Partnership Services – Older Adults: Juvenile Halls and Camps FY 09-10 New Enrollees Only 220 Small Counties are grouped together in the table 221 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County – Pre FSP – Post FSP Days Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz** -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study **No new enrollees in FY 09-10 220 See Appendix D for County Participants 221 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Napa, San Benito, Shasta, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra, Colusa, Del Norte, and Mono counties did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 278 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.74 Full Service Partnership Services – Children, Youth and Families: Jail FY 08-09 New Enrollees Only 222 Small Counties are grouped together in the table 223 Children, Youth, and Families Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Days County FSP FSP Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz* -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 222 See Appendix D for County Participants 223 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 279 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.75 Full Service Partnership Services – Children, Youth and Families: Jail FY 09-10 New Enrollees Only 224 Small Counties are grouped together in the table 225 Children, Youth, and Families Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent – Pre FSP – Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara 0 5 -5 -- $668.10 ($668.10) 0.0% Santa Cruz* -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 224 See Appendix D for County Participants 225 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Lake, Lassen, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Humboldt, Inyo, Mono and Tehama counties did not provide FSP services in FY 08-09/FY 09-10 to CYF, nor claim expenditures for CYF in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 280 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.76 Full Service Partnership Services – Transition Age Youth: Jail FY 08-09 New Enrollees Only 226 Small Counties are grouped together in the table 227 Transition Age Youth Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year Pre FSP Year Post FSP Days County Butte 73 143 -70 $6,853.97 $13,426.27 ($6,572.30) -95.9% Contra Costa 149 71 78 $22,098.19 $10,530.01 $11,568.18 52.3% Fresno 592 8 584 $34,596.48 $467.52 $34,128.96 98.6% Kern 1,937 37 1,900 $192,014.81 $3,667.81 $188,347.00 98.1% Los Angeles 3,488 628 2,860 $3,812,384.00 $686,404.00 $3,125,980.00 82.0% Merced 82 0 82 $12,944.52 $0.00 $12,944.52 100.0% Orange 4,322 918 3,404 $566,182.00 $120,258.00 $445,924.00 78.8% Placer 105 39 66 $16,590.00 $6,162.00 $10,428.00 62.9% San Bernardino 3,608 969 2,639 $277,491.28 $74,525.79 $202,965.49 73.1% San Diego 2,050 1,093 957 $303,195.00 $161,654.70 $141,540.30 46.7% San Francisco 342 380 -38 $36,778.68 $40,865.20 ($4,086.52) -11.1% San Joaquin 1,732 145 1,587 $204,445.28 $17,115.80 $187,329.48 91.6% San Luis Obispo -- -- -- -- -- -- -- Santa Clara 2,698 460 2,238 $360,506.76 $61,465.20 $299,041.56 83.0% Santa Cruz -- -- -- -- -- -- -- Small Counties 799 361 438 $113,835.81 $51,404.21 $62,431.60 54.8% Solano 11 9 2 $132.00 $108.00 $24.00 18.2% Sonoma 814 103 711 $125,144.36 $15,835.22 $109,309.14 87.3% Stanislaus 674 175 499 $76,903.40 $19,967.50 $56,935.90 74.0% Tulare 511 70 441 $32,959.50 $4,515.00 $28,444.50 86.3% Ventura 829 220 609 $104,909.95 $27,841.00 $77,068.95 73.5% 226 See Appendix D for County Participants 227 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 281 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.77 Full Service Partnership Services – Transition Age Youth: Jail FY 09-10 New Enrollees Only 228 Small Counties are grouped together in the table 229 Transition Age Youth Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte 66 0 66 $6,196.74 $0.00 $6,196.74 100.0% Contra Costa 1,443 1,115 328 $214,011.33 $165,365.65 $48,645.68 22.7% Fresno 445 274 171 $26,005.80 $16,012.56 $9,993.24 38.4% Kern 1,883 326 1,557 $186,661.79 $32,316.38 $154,345.41 82.7% Los Angeles 3,998 549 3,449 $4,369,814.00 $600,057.00 $3,769,757.00 86.3% Merced 9 133 -124 $1,420.74 $20,995.38 ($19,574.64) -1,377.8% Orange 1,925 757 1,168 $252,175.00 $99,167.00 $153,008.00 60.7% Placer 405 9 396 $63,990.00 $1,422.00 $62,568.00 97.8% San Bernardino 3,670 183 3,487 $282,259.70 $14,074.53 $268,185.17 95.0% San Diego 2,189 434 1,755 $323,753.10 $64,188.60 $259,564.50 80.2% San Francisco 0 15 -15 $0.00 $1,613.10 ($1,613.10) 0.0% San Joaquin 128 245 -117 $15,109.12 $28,919.80 ($13,810.68) -91.4% San Luis Obispo 0 94 -94 $0.00 $9,697.04 ($9,697.04) 0.0% Santa Clara 3,594 1,063 2,531 $480,230.28 $142,038.06 $338,192.22 70.4% Santa Cruz** -- -- -- -- -- -- -- Small Counties 594 504 90 $89,951.56 $76,322.53 $13,629.03 15.2% Solano 225 0 225 $2,700.00 $0.00 $2,700.00 100.0% Sonoma 510 187 323 $78,407.40 $28,749.38 $49,658.02 63.3% Stanislaus 921 218 703 $105,086.10 $24,873.80 $80,212.30 76.3% Tulare 409 201 208 $26,380.50 $12,964.50 $13,416.00 50.9% Ventura 1,170 578 592 $128,957.40 $63,707.16 $65,250.24 50.6% **No new enrollees in FY 09-10 228 See Appendix D for County Participants 229 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 282 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.78 Full Service Partnership Services – Adults: Jail FY 08-09 New Enrollees Only 230 Small Counties are grouped together in the table 231 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County Pre FSP Post FSP Days Butte 141 0 141 $13,238.49 $0.00 $13,238.49 100.0% Contra Costa 317 256 61 $47,014.27 $37,967.36 $9,046.91 19.2% Fresno 2,636 311 2,325 $154,047.84 $18,174.84 $135,873.00 88.2% Kern 5,527 130 5,397 $547,891.51 $12,886.90 $535,004.61 97.6% Los Angeles 26,074 2,210 23,864 $28,498,882.00 $2,415,530.00 $26,083,352.00 91.5% Merced 387 3 384 $61,091.82 $473.58 $60,618.24 99.2% Orange 10,032 1,774 8,258 $1,314,192.00 $232,394.00 $1,081,798.00 82.3% Placer 506 412 94 $79,948.00 $65,096.00 $14,852.00 18.6% San Bernardino 9,593 1,403 8,190 $737,797.63 $107,904.73 $629,892.90 85.4% San Diego 3,451 1,147 2,304 $510,402.90 $169,641.30 $340,761.60 66.8% San Francisco 665 483 182 $71,514.10 $51,941.82 $19,572.28 27.4% San Joaquin 4,203 340 3,863 $496,122.12 $40,133.60 $455,988.52 91.9% San Luis Obispo 0 39 -39 $0.00 $4,023.24 ($4,023.24) 0.0% Santa Clara 11,526 2,063 9,463 $1,540,104.12 $275,658.06 $1,264,446.06 82.1% Santa Cruz 72 0 72 $5,556.24 $0.00 $5,556.24 100.0% Small Counties 3,056 544 2,512 $435,397.05 $77,505.23 $357,891.82 82.2% Solano 372 10 362 $4,464.00 $120.00 $4,344.00 97.3% Sonoma 1,880 109 1,771 $289,031.20 $16,757.66 $272,273.54 94.2% Stanislaus 2,206 738 1,468 $251,704.60 $84,205.80 $167,498.80 66.5% Tulare 891 298 593 $57,469.50 $19,221.00 $38,248.50 66.6% Ventura 1,219 329 890 $154,264.45 $41,634.95 $112,629.50 73.0% 230 See Appendix D for County Participants 231 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 283 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.79 Full Service Partnership Services – Adults: Jail FY 09-10 New Enrollees Only 232 Small Counties are grouped together in the table 233 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte 74 0 74 $6,947.86 $0.00 $6,947.86 100.0% Contra Costa 949 212 737 $140,746.19 $31,441.72 $109,304.47 77.7% Fresno 1,815 386 1,429 $106,068.60 $22,557.84 $83,510.76 78.7% Kern 4,128 390 3,738 $409,208.64 $38,660.70 $370,547.94 90.6% Los Angeles 20,803 1,907 18,896 $22,737,679.00 $2,084,351.00 $20,653,328.00 90.8% Merced -- -- -- -- -- -- -- Orange 8,034 1,299 6,735 $1,052,454.00 $170,169.00 $882,285.00 83.8% Placer 711 79 632 $112,338.00 $12,482.00 $99,856.00 88.9% San Bernardino 8,529 395 8,134 $655,965.39 $30,379.45 $625,585.94 95.4% San Diego 4,592 1,836 2,756 $679,156.80 $271,544.40 $407,612.40 60.0% San Francisco 2,021 423 1,598 $217,338.34 $45,489.42 $171,848.92 79.1% San Joaquin 2,588 312 2,276 $305,487.52 $36,828.48 $268,659.04 87.9% San Luis Obispo 0 222 -222 $0.00 $22,901.52 ($22,901.52) 0.0% Santa Clara 9,724 1,710 8,014 $1,299,320.88 $228,490.20 $1,070,830.68 82.4% Santa Cruz** -- -- -- -- -- -- -- Small Counties 3,149 581 2,568 $476,864.41 $87,982.92 $388,881.49 81.5% Solano 1,216 5 1,211 $14,592.00 $60.00 $14,532.00 99.6% Sonoma 682 101 581 $104,850.68 $15,527.74 $89,322.94 85.2% Stanislaus 915 262 653 $104,401.50 $29,894.20 $74,507.30 71.4% Tulare 1,031 292 739 $66,499.50 $18,834.00 $47,665.50 71.7% Ventura 1,665 640 1,025 $183,516.30 $70,540.80 $112,975.50 61.6% **No new enrollees in FY 09-10 232 See Appendix D for County Participants 233 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 284 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.80 Full Service Partnership Services – Older Adults: Jail FY 08-09 New Enrollees Only 234 Small Counties are grouped together in the table 235 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno 1 0 1 $58.44 $0.00 $58.44 100.0% Kern -- -- -- -- -- -- -- Los Angeles 1,771 36 1,735 $1,935,703.00 $39,348.00 $1,896,355.00 98.0% Merced -- -- -- -- -- -- -- Orange 464 13 451 $60,784.00 $1,703.00 $59,081.00 97.2% Placer 14 0 14 $2,212.00 $0.00 $2,212.00 100.0% San Bernardino -- -- -- -- -- -- -- San Diego 182 0 182 $26,917.80 $0.00 $26,917.80 100.0% San Francisco 0 28 -28 $0.00 $3,011.12 ($3,011.12) 0.0% San Joaquin 0 11 -11 $0.00 $1,298.44 ($1,298.44) 0.0% San Luis Obispo -- -- -- -- -- -- -- Santa Clara 60 0 60 $8,017.20 $0.00 $8,017.20 100.0% Santa Cruz -- -- -- -- -- -- -- Small Counties 138 0 138 $19,661.25 $0.00 $19,661.25 100.0% Solano 0 7 -7 $0.00 $84.00 ($84.00) 0.0% Sonoma 196 0 196 $30,133.04 $0.00 $30,133.04 100.0% Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura 128 0 128 $16,198.40 $0.00 $16,198.40 100.0% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 234 See Appendix D for County Participants 235 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra County did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claimed expenditures for Older Adults in the study, and is therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 285 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.81 Full Service Partnership Services – Older Adults: Jail FY 09-10 New Enrollees Only 236 Small Counties are grouped together in the table 237 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County – Pre FSP – Post FSP Days Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern 149 0 149 $14,770.37 $0.00 $14,770.37 100.0% Los Angeles 861 82 779 $941,073.00 $89,626.00 $851,447.00 90.5% Merced -- -- -- -- -- -- -- Orange 108 42 66 $14,148.00 $5,502.00 $8,646.00 61.1% Placer 2 0 2 $316.00 $0.00 $316.00 100.0% San Bernardino 230 0 230 $17,689.30 $0.00 $17,689.30 100.0% San Diego 75 43 32 $11,092.50 $6,359.70 $4,732.80 42.7% San Francisco -- -- -- -- -- -- -- San Joaquin 364 0 364 $42,966.56 $0.00 $42,966.56 100.0% San Luis Obispo -- -- -- -- -- -- -- Santa Clara 365 0 365 $48,771.30 $0.00 $48,771.30 100.0% Santa Cruz** -- -- -- -- -- -- -- Small Counties 158 4 154 $23,926.51 $605.73 $23,320.78 97.5% Solano 22 0 22 $264.00 $0.00 $264.00 100.0% Sonoma -- -- -- -- -- -- -- Stanislaus 0 54 -54 $0.00 $6,161.40 ($6,161.40) 0.0% Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study **No new enrollees in FY 09-10 236 See Appendix D for County Participants 237 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Napa, San Benito, Shasta, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra, Colusa, Del Norte, and Mono counties did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 286 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.82 Full Service Partnership Services – Children, Youth and Families: Prison FY 08-09 New Enrollees Only 238 Small Counties are grouped together in the table 239 Children, Youth, and Families Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Days County FSP FSP Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz* -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 238 See Appendix D for County Participants 239 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 287 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.83 Full Service Partnership Services – Children, Youth and Families: Prison FY 09-10 New Enrollees Only 240 Small Counties are grouped together in the table 241 Children, Youth, and Families Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent – Pre FSP – Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz* -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 240 See Appendix D for County Participants 241 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Lake, Lassen, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Humboldt, Inyo, Mono and Tehama counties did not provide FSP services in FY 08-09/FY 09-10 to CYF, nor claim expenditures for CYF in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 288 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.84 Full Service Partnership Services – Transition Age Youth: Prison FY 08-09 New Enrollees Only 242 Small Counties are grouped together in the table 243 Transition Age Youth Number of Number of Decrease in Days Per Days Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year Pre FSP Year Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno 180 0 180 $23,229.00 $0.00 $23,229.00 100.0% Kern -- -- -- -- -- -- -- Los Angeles 488 0 488 $62,976.40 $0.00 $62,976.40 100.0% Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino 390 0 390 $50,329.50 $0.00 $50,329.50 100.0% San Diego 0 25 -25 $0.00 $3,226.25 ($3,226.25) 0.0% San Francisco -- -- -- -- -- -- -- San Joaquin 185 0 185 $23,874.25 $0.00 $23,874.25 100.0% San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- 242 See Appendix D for County Participants 243 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 289 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.85 Full Service Partnership Services – Transition Age Youth: Prison FY 09-10 New Enrollees Only 244 Small Counties are grouped together in the table 245 Transition Age Youth Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern 98 0 98 $13,425.02 $0.00 $13,425.02 100.0% Los Angeles 200 0 200 $27,398.00 $0.00 $27,398.00 100.0% Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino 187 0 187 $24,132.35 $0.00 $24,132.35 100.0% San Diego 200 0 200 $27,398.00 $0.00 $27,398.00 100.0% San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo 0 180 -180 $0.00 $24,658.20 ($24,658.20) 0.0% Santa Clara 457 0 457 $62,604.43 $0.00 $62,604.43 100.0% Santa Cruz** -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- **No new enrollees in FY 09-10 244 See Appendix D for County Participants 245 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 290 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.86 Full Service Partnership Services – Adults: Prison FY 08-09 New Enrollees Only 246 Small Counties are grouped together in the table 247 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County Pre FSP Post FSP Days Butte 271 0 271 $34,972.55 $0.00 $34,972.55 100.0% Contra Costa 4 0 4 $516.20 $0.00 $516.20 100.0% Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles 558 0 558 $72,009.90 $0.00 $72,009.90 100.0% Merced 30 0 30 $3,871.50 $0.00 $3,871.50 100.0% Orange 794 0 794 $102,465.70 $0.00 $102,465.70 100.0% Placer -- -- -- -- -- -- -- San Bernardino 753 0 753 $97,174.65 $0.00 $97,174.65 100.0% San Diego 333 0 333 $42,973.65 $0.00 $42,973.65 100.0% San Francisco 265 0 265 $34,198.25 $0.00 $34,198.25 100.0% San Joaquin 434 0 434 $56,007.70 $0.00 $56,007.70 100.0% San Luis Obispo -- -- -- -- -- -- -- Santa Clara 172 0 172 $22,196.60 $0.00 $22,196.60 100.0% Santa Cruz -- -- -- -- -- -- -- Small Counties 179 0 179 $23,099.95 $0.00 $23,099.95 100.0% Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus 167 0 167 $21,551.35 $0.00 $21,551.35 100.0% Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- 246 See Appendix D for County Participants 247 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 291 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.87 Full Service Partnership Services – Adults: Prison FY 09-10 New Enrollees Only 248 Small Counties are grouped together in the table 249 Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles 834 0 834 $114,249.66 $0.00 $114,249.66 100.0% Merced -- -- -- -- -- -- -- Orange 930 0 930 $127,400.70 $0.00 $127,400.70 100.0% Placer -- -- -- -- -- -- -- San Bernardino 697 0 697 $89,947.85 $0.00 $89,947.85 100.0% San Diego 371 0 371 $50,823.29 $0.00 $50,823.29 100.0% San Francisco 243 0 243 $33,288.57 $0.00 $33,288.57 100.0% San Joaquin 368 0 368 $50,412.32 $0.00 $50,412.32 100.0% San Luis Obispo -- -- -- -- -- -- -- Santa Clara 2,732 0 2,732 $374,256.68 $0.00 $374,256.68 100.0% Santa Cruz** -- -- -- -- -- -- -- Small Counties 245 0 245 $31,617.25 $0.00 $31,617.25 100.0% Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus 324 0 324 $44,384.76 $0.00 $44,384.76 100.0% Tulare 120 0 120 $16,438.80 $0.00 $16,438.80 100.0% Ventura -- -- -- -- -- -- -- **No new enrollees in FY 09-10 248 See Appendix D for County Participants 249 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 292 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.88 Full Service Partnership Services – Older Adults: Prison FY 08-09 New Enrollees Only 250 Small Counties are grouped together in the table 251 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent Pre FSP Post FSP Days County Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles 562 0 562 $72,526.10 $0.00 $72,526.10 100.0% Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara -- -- -- -- -- -- -- Santa Cruz -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 250 See Appendix D for County Participants 251 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra County did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and is therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 293 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.89 Full Service Partnership Services – Older Adults: Prison FY 09-10 New Enrollees Only 252 Small Counties are grouped together in the table 253 Older Adults Number of Number of Decrease in Days Per Year Days Per Year Number of Pre FSP Cost Post FSP Cost Total Offset Percent County – Pre FSP – Post FSP Days Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern -- -- -- -- -- -- -- Los Angeles -- -- -- -- -- -- -- Merced -- -- -- -- -- -- -- Orange -- -- -- -- -- -- -- Placer -- -- -- -- -- -- -- San Bernardino -- -- -- -- -- -- -- San Diego -- -- -- -- -- -- -- San Francisco -- -- -- -- -- -- -- San Joaquin -- -- -- -- -- -- -- San Luis Obispo -- -- -- -- -- -- -- Santa Clara 65 0 65 $8,904.35 $0.00 $8,904.35 100.0% Santa Cruz** -- -- -- -- -- -- -- Small Counties -- -- -- -- -- -- -- Solano -- -- -- -- -- -- -- Sonoma -- -- -- -- -- -- -- Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura -- -- -- -- -- -- -- *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study **No new enrollees in FY 09-10 252 See Appendix D for County Participants 253 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Napa, San Benito, Shasta, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra, Colusa, Del Norte, and Mono counties did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 294 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.90 Full Service Partnership Services – Children, Youth and Families: Arrests FY 08-09 New Enrollees Only 254 Small Counties are grouped together in the table 255 Children, Youth, and Families Number of Number of Decrease in Arrests Per Arrests Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Arrests County FSP FSP Butte 3 0 3 $26.26 $0.00 $26.26 100.0% Contra Costa 4 1 3 $215.13 $53.78 $161.35 75.0% Fresno -- -- -- -- -- -- -- Kern 9 1 8 $122.33 $13.59 $108.74 88.9% Los Angeles 95 9 86 $149.99 $14.21 $135.78 90.5% Merced 12 1 11 $247.10 $20.59 $226.51 91.7% Orange 15 2 13 $818.60 $109.15 $709.45 86.7% Placer 2 0 2 $69.72 $0.00 $69.72 100.0% San Bernardino 65 24 41 $1,617.39 $597.19 $1,020.20 63.1% San Diego 24 13 11 $1,121.29 $607.37 $513.92 45.8% San Francisco 30 18 12 $1,529.56 $917.74 $611.82 40.0% San Joaquin 7 4 3 $129.26 $73.86 $55.40 42.9% San Luis Obispo 8 13 -5 $272.00 $441.99 ($169.99) -62.5% Santa Clara 25 9 16 $1,155.88 $416.12 $739.76 64.0% Santa Cruz* -- -- -- -- -- -- -- Small Counties 96 13 83 $2,052.58 $277.95 $1,774.63 86.5% Solano 7 2 5 $285.89 $81.68 $204.21 71.4% Sonoma 5 0 5 $152.86 $9.17 $143.69 94.0% Stanislaus 12 0 12 $343.74 $0.00 $343.74 100.0% Tulare -- -- -- -- -- -- -- Ventura 48 25 23 $2,333.18 $1,215.20 $1,117.98 47.9% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 254 See Appendix D for County Participants 255 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 295 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.91 Full Service Partnership Services – Children, Youth and Families: Arrests FY 09-10 New Enrollees Only 256 Small Counties are grouped together in the table 257 Children, Youth, and Families Number of Number of Decrease in Arrests Per Arrests Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Arrests County FSP FSP Butte -- -- -- -- -- -- -- Contra Costa 2 0 2 $93.15 $0.00 $93.15 100.0% Fresno 62 11 51 $1,388.71 $246.38 $1,142.33 82.3% Kern 2 4 -2 $23.12 $46.24 ($23.12) -100.0% Los Angeles 89 5 84 $121.96 $6.85 $115.11 94.4% Merced 3 6 -3 $54.88 $109.76 ($54.88) -100.0% Orange 3 1 2 $139.96 $27.99 $111.97 80.0% Placer -- -- -- -- -- -- -- San Bernardino 162 59 103 $3,666.78 $1,335.43 $2,331.35 63.6% San Diego 39 17 22 $1,524.51 $664.53 $859.98 56.4% San Francisco 34 6 28 $1,520.18 $268.27 $1,251.91 82.4% San Joaquin 14 2 12 $238.88 $34.13 $204.75 85.7% San Luis Obispo 4 3 1 $110.60 $82.95 $27.65 25.0% Santa Clara 23 9 14 $972.35 $380.48 $591.87 60.9% Santa Cruz* -- -- -- -- -- -- -- Small Counties 99 19 80 $1,766.55 $339.04 $1,427.51 80.8% Solano 2 0 2 $77.93 $0.00 $77.93 100.0% Sonoma 3 1 2 $22.47 $4.49 $17.98 80.0% Stanislaus 17 4 13 $444.63 $104.62 $340.01 76.5% Tulare -- -- -- -- -- -- -- Ventura 20 7 13 $810.61 $283.71 $526.90 65.0% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for CYF in study 256 See Appendix D for County Participants 257 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Lake, Lassen, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Humboldt, Inyo, Mono and Tehama counties did not provide FSP services in FY 08-09/FY 09-10 to CYF, nor claim expenditures for CYF in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 296 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.92 Full Service Partnership Services – Transition Age Youth: Arrests FY 08-09 New Enrollees Only 258 Small Counties are grouped together in the table 259 Transition Age Youth Number of Number of Decrease in Arrests Per Arrests Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Arrests County FSP FSP Butte 17 12 5 $148.80 $105.04 $43.76 29.4% Contra Costa 16 4 12 $860.51 $215.13 $645.38 75.0% Fresno 45 6 39 $1,137.60 $151.68 $985.92 86.7% Kern 61 1 60 $829.11 $13.59 $815.52 98.4% Los Angeles 173 13 160 $273.15 $20.53 $252.62 92.5% Merced 17 2 15 $350.06 $41.18 $308.88 88.2% Orange 258 57 201 $14,079.98 $3,110.69 $10,969.29 77.9% Placer 3 0 3 $104.58 $0.00 $104.58 100.0% San Bernardino 253 51 202 $6,295.39 $1,269.03 $5,026.36 79.8% San Diego 80 10 70 $3,737.65 $467.21 $3,270.44 87.5% San Francisco 59 12 47 $3,008.14 $611.83 $2,396.31 79.7% San Joaquin 81 8 73 $1,495.73 $147.73 $1,348.00 90.1% San Luis Obispo 7 0 7 $238.00 $0.00 $238.00 100.0% Santa Clara 67 13 54 $3,097.75 $601.06 $2,496.69 80.6% Santa Cruz 2 0 2 $75.87 $0.00 $75.87 100.0% Small Counties 146 34 112 $3,121.63 $735.51 $2,386.12 76.4% Solano 8 3 5 $326.73 $122.53 $204.20 62.5% Sonoma 11 0 11 $336.29 $0.00 $336.29 100.0% Stanislaus 26 0 26 $744.77 $0.00 $744.77 100.0% Tulare 23 2 21 $702.40 $61.08 $641.32 91.3% Ventura 79 24 55 $3,840.02 $1,166.59 $2,673.43 69.6% 258 See Appendix D for County Participants 259 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 297 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.93 Full Service Partnership Services – Transition Age Youth: Arrests FY 09-10 New Enrollees Only 260 Small Counties are grouped together in the table 261 Transition Age Youth Number of Number of Decrease in Arrests Per Arrests Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Arrests County FSP FSP Butte 12 1 11 $89.88 $7.49 $82.39 91.7% Contra Costa 22 13 9 $1,024.69 $605.50 $419.19 40.9% Fresno 79 12 67 $1,769.48 $268.78 $1,500.70 84.8% Kern 72 4 68 $832.25 $46.24 $786.01 94.4% Los Angeles 222 12 210 $304.21 $16.44 $287.77 94.6% Merced 13 1 12 $237.82 $18.29 $219.53 92.3% Orange 133 17 116 $6,204.96 $793.12 $5,411.84 87.2% Placer 5 0 5 $159.29 $0.00 $159.29 100.0% San Bernardino 318 66 252 $7,197.75 $1,493.87 $5,703.88 79.2% San Diego 172 17 155 $6,723.47 $664.53 $6,058.94 90.1% San Francisco 39 6 33 $1,743.74 $268.27 $1,475.47 84.6% San Joaquin 56 10 46 $955.53 $170.63 $784.90 82.1% San Luis Obispo 18 6 12 $497.68 $165.89 $331.79 66.7% Santa Clara 108 29 79 $4,565.81 $1,226.00 $3,339.81 73.1% Santa Cruz** -- -- -- -- -- -- -- Small Counties 226 33 193 $4,032.74 $588.85 $3,443.89 85.4% Solano 14 0 14 $545.51 $0.00 $545.51 100.0% Sonoma 16 1 15 $119.84 $5.99 $113.85 95.0% Stanislaus 48 15 33 $1,255.41 $392.32 $863.09 68.7% Tulare 26 1 26 $687.95 $13.23 $674.72 98.1% Ventura 218 49 169 $8,835.69 $1,986.00 $6,849.69 77.5% **No new enrollees in FY 09-10 260 See Appendix D for County Participants 261 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 298 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.94 Full Service Partnership Services – Adults: Arrests FY 08-09 New Enrollees Only 262 Small Counties are grouped together in the table 263 Adults Number of Number of Decrease in Arrests Per Arrests Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Arrests County FSP FSP Butte 15 1 14 $131.30 $8.75 $122.55 93.3% Contra Costa 30 9 21 $1,613.45 $484.03 $1,129.42 70.0% Fresno 62 8 54 $1,567.36 $202.24 $1,365.12 87.1% Kern 98 2 96 $1,332.01 $27.18 $1,304.83 98.0% Los Angeles 463 61 402 $731.02 $96.31 $634.71 86.8% Merced 11 2 9 $226.51 $41.18 $185.33 81.8% Orange 225 12 213 $12,279.06 $654.88 $11,624.18 94.7% Placer 23 7 16 $801.79 $244.02 $557.77 69.6% San Bernardino 250 102 148 $6,220.74 $2,538.06 $3,682.68 59.2% San Diego 96 11 85 $4,485.18 $513.93 $3,971.25 88.5% San Francisco 64 20 44 $3,263.07 $1,019.71 $2,243.36 68.7% San Joaquin 134 10 124 $2,474.42 $184.66 $2,289.76 92.5% San Luis Obispo 8 2 6 $272.00 $68.00 $204.00 75.0% Santa Clara 147 20 127 $6,796.55 $924.70 $5,871.85 86.4% Santa Cruz 8 1 7 $303.46 $30.35 $273.11 90.0% Small Counties 149 25 124 $3,185.77 $534.52 $2,651.25 83.2% Solano 3 2 1 $122.53 $81.68 $40.85 33.3% Sonoma 25 0 25 $764.30 $0.00 $764.30 100.0% Stanislaus 80 20 60 $2,291.60 $572.90 $1,718.70 75.0% Tulare 42 10 32 $1,282.64 $305.39 $977.25 76.2% Ventura 48 15 33 $2,333.18 $729.12 $1,604.06 68.7% 262 See Appendix D for County Participants 263 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Sierra, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 299 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.95 Full Service Partnership Services – Adults: Arrests FY 09-10 New Enrollees Only 264 Small Counties are grouped together in the table 265 Adults Number of Number of Decrease in Arrests Per Arrests Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Arrests County FSP FSP Butte 11 0 11 $82.39 $0.00 $82.39 100.0% Contra Costa 21 15 6 $978.11 $698.65 $279.46 28.6% Fresno 34 7 27 $761.55 $156.79 $604.76 79.4% Kern 100 0 100 $1,155.90 $0.00 $1,155.90 100.0% Los Angeles 373 52 321 $511.13 71.26 $439.87 86.1% Merced 1 0 1 $18.29 $0.00 $18.29 100.0% Orange 156 13 143 $7,278.00 $606.50 $6,671.50 91.7% Placer 18 0 18 $573.44 $0.00 $573.44 100.0% San Bernardino 212 29 183 $4,798.50 $656.40 $4,142.10 86.3% San Diego 159 66 93 $6,215.30 $2,579.93 $3,635.37 58.5% San Francisco 48 6 42 $2,146.14 $268.27 $1,877.87 87.5% San Joaquin 100 13 87 $1,706.30 $221.82 $1,484.48 87.0% San Luis Obispo 32 7 25 $884.77 $193.54 $691.23 78.1% Santa Clara 146 14 132 $6,172.29 $591.86 $5,580.43 90.4% Santa Cruz** -- -- -- -- -- -- -- Small Counties 152 48 104 $2,712.28 $854.73 $1,857.55 68.5% Solano 48 1 47 $1,870.32 $38.96 $1,831.36 97.9% Sonoma 40 2 38 $299.61 $14.98 $284.63 95.0% Stanislaus 23 5 18 $601.55 $130.77 $470.78 78.3% Tulare 44 3 41 $1,164.22 $79.38 $1,084.84 93.2% Ventura 96 35 61 $3,890.95 $1,418.57 $2,472.38 63.5% **No new enrollees in FY 09-10 264 See Appendix D for County Participants 265 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Mono, Napa, San Benito, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 300 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.96 Full Service Partnership Services – Older Adults: Arrests FY 08-09 New Enrollees Only 266 Small Counties are grouped together in the table 267 Older Adults Number of Number of Decrease in Arrests Per Arrests Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Pre Year – Post Arrests County FSP FSP Butte -- -- -- -- -- -- -- Contra Costa* -- -- -- -- -- -- -- Fresno 1 0 1 $25.28 $0.00 $25.28 100.0% Kern -- -- -- -- -- -- -- Los Angeles 17 1 16 $26.84 $1.58 $25.26 94.1% Merced -- -- -- -- -- -- -- Orange 3 0 3 $163.72 $21.83 $141.89 86.7% Placer 3 0 3 $104.58 $0.00 $104.58 100.0% San Bernardino -- -- -- -- -- -- -- San Diego 4 0 4 $186.88 $0.00 $186.88 100.0% San Francisco 3 0 3 $152.96 $0.00 $152.96 100.0% San Joaquin 3 1 2 $55.40 $12.93 $42.47 76.7% San Luis Obispo 2 0 2 $68.00 $0.00 $68.00 100.0% Santa Clara 1 0 1 $46.24 $0.00 $46.24 100.0% Santa Cruz -- -- -- -- -- -- -- Small Counties 2 0 2 $42.76 $0.00 $42.76 100.0% Solano 1 0 1 $40.84 $0.00 $40.84 100.0% Sonoma 3 0 3 $91.72 $0.00 $91.72 100.0% Stanislaus -- -- -- -- -- -- -- Tulare -- -- -- -- -- -- -- Ventura 3 0 3 $145.82 $0.00 $145.82 100.0% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study 266 See Appendix D for County Participants 267 Small counties included for purpose of FY 08-09 analyses = El Dorado, Glenn, Imperial, Lake, Madera, Napa, San Benito, Shasta, Siskiyou, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra County did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claimed expenditures for Older Adults in the study, and is therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 301 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets Table H.97 Full Service Partnership Services – Older Adults: Arrests FY 09-10 New Enrollees Only 268 Small Counties are grouped together in the table 269 Older Adults Number of Number of Decrease in Arrests Per Arrests Per Number of Pre FSP Cost Post FSP Cost Total Offset Percent Year – Post County Year – Pre FSP FSP Arrests Butte 11 0 11 $82.39 $0.00 $82.39 100.0% Contra Costa* -- -- -- -- -- -- -- Fresno -- -- -- -- -- -- -- Kern 3 0 3 $34.68 $0.00 $34.68 100.0% Los Angeles 13 4 9 $17.81 $5.48 $12.33 69.2% Merced -- -- -- -- -- -- -- Orange 7 0 7 $326.58 $0.00 $326.58 100.0% Placer 1 0 1 $31.86 $0.00 $31.86 100.0% San Bernardino 2 0 2 $45.27 $0.00 $45.27 100.0% San Diego 8 3 5 $312.72 $117.27 $195.45 62.5% San Francisco 1 0 1 $44.71 $0.00 $44.71 100.0% San Joaquin 3 2 1 $51.19 $34.13 $17.06 33.3% San Luis Obispo 4 0 4 $110.60 $0.00 $110.60 100.0% Santa Clara 4 0 4 $169.10 $0.00 $169.10 100.0% Santa Cruz** -- -- -- -- -- -- -- Small Counties 13 2 11 $231.97 $35.69 $196.28 84.6% Solano 6 0 6 $233.79 $0.00 $233.79 100.0% Sonoma -- -- -- -- -- -- -- Stanislaus 0 1 -1 $0.00 $26.15 ($26.15) 0.0% Tulare -- -- -- -- -- -- -- Ventura 2 1 2 $81.06 $20.27 $60.79 75.0% *Did not provide FSP services in FY 08-09/FY 09-10, nor claim FSP expenditures for Older Adults in study **No new enrollees in FY 09-10 268 See Appendix D for County Participants 269 Small counties included for purpose of FY 09-10 analyses = Amador, Calaveras, El Dorado, Glenn, Humboldt, Imperial, Inyo, Lake, Lassen, Madera, Napa, San Benito, Shasta, Siskiyou, Tehama, Trinity, Tuolumne, and Yolo. Although Alpine, Berkeley, and Mendocino are considered “small,” they do not submit data on individual FSPs into the DCR, and therefore the annualized expenditure per person and cost offset analyses could not be conducted. Sierra, Colusa, Del Norte, and Mono counties did not provide FSP services in FY 08-09/FY 09-10 to Older Adults, nor claim expenditures for Older Adults in the study, and are therefore not included in the Small County pool. Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 302 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets This page is intentionally blank Full Service Partnerships: California’s Investment to Support Children and Transition-Age Youth with Serious Page 303 Emotional Disturbance and Adults and Older Adults with Severe Mental Illness – Contextual Factors and the Relationship to Expenditures and Cost Offsets