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Santa Maria Sun / News

The following article was posted on April 30th, 2014, in the Santa Maria Sun - Volume 15, Issue 8 [ Submit a Story ]
The following articles were printed from Santa Maria Sun [santamariasun.com] - Volume 15, Issue 8

ADMHS's systemic overhaul comes with a price tag

BY CAMILLIA LANHAM

Systemic change comes with a lot of adjectives. At the Santa Barbara County Department of Alcohol, Drug, and Mental Health Services (ADMHS), that overhaul is described as a “comprehensive system change effort.” It’s one of those terms most people roll their eyes at. It’s management jargon.

What do those terms mean—in easily understandable terms—for an agency that’s been underfunded and complained about for years?

Well, 4th District Supervisor Peter Adam was wondering that same thing, and said so at the beginning of a progress report ADMHS presented during the Santa Barbara County Board of Supervisors meeting on April 22.

“I’m seeing a lot of adjectives,” Adam told ADMHS executive staff. “I’d like to see some verbs. I’d like to hear what the plan is, including actions.”

Eventually the layman’s version of the plan came out, disbursed in bits and pieces throughout the presentation. Adam wasn’t the only supervisor who wanted to know how progress was being measured in real terms; 1st District Supervisor Salud Carbajal also questioned what metrics were being used to measure success. The answer was: Those metrics are being set now, and can be used to measure progress in the coming years.

Change comes slowly and begins at the top. It starts with agency’s vision for itself; its treatment philosophy, transition services, wait times, accessibility, stakeholder involvement, and the list of big words continues. For instance, the agency no longer treats patients based on their insurance or how much they can afford to pay for services; it now treats people based on what their needs are. Another big change is creating a treatment plan with the patient rather than for the patient.

According to ADMHS head honchos updating the Board of Supervisors, the tracks are laid: The new vision is starting to trickle down through the ranks and is even beginning to show itself in the way the agency provides services to people who need them.

One good example is wait times. Rather than waiting 60 to 70 days to see a psychiatrist, patients now only have to wait 40 to 45 days for an appointment. It’s not great, but it’s progress. Dr. Takashi Wada, ADMHS interim director, said the goal is to eventually bring that wait time down to a standard of 10 days or less, but the department needs to hire about five more psychiatrists to do so. That’s extra money that needs to come out of the county’s general fund, and so far supervisors have been reluctant to make the financial commitment.

All this strategizing for change began after a report requested by the Board of Supervisors was completed in 2013. The TriWest Group, an independent consulting organization, performed the assessment and determined that “the ADMHS adult and children’s systems of care were not producing the clinical outcomes for the residents of Santa Barbara County that would demonstrate effective use of available resources.”

Things got rolling in May of last year.

“The first year is going to be more of a baseline,” Wada said during the April 22 Board of Supervisors meeting.

Initially, though, the community is already responding positively.

“One of my big metrics of success is I’m not hearing about ADMHS anymore,” 3rd District Supervisor Doreen Farr said during the meeting. “This is really quite tremendous if you consider where we were.”

She added that the complaints about ADMHS were constant before, but that has changed. Not all of the supes agreed with Farr; Carbajal said he is still getting complaints.

Carbajal referred to two people who spoke up during the public comment portion of the meeting. They said it took more than six months to get Carpenteria the psych services it was promised, which, he said, is much too long.

“Not to be a wet blanket,” Carbajal said, “but, it’s important we put our resources together to complete something effectively.”

The plan is for things to continue to get better. This year, the agency has already received more than $10 million in grants that are being put toward mental health crisis services. The money will be used to put a mobile crisis support team in Lompoc, a residential crisis house in South County, and people to staff both programs. The hope is those upgrades will result in fewer people needing emergency intensive services, which are the most expensive to provide.

The most expensive clients make up 35 percent of insurance claims for the organization, but in most other counties, the most costly patients only make up an average of 22 percent of costs, according to Michael Craft, the assistant director of clinical programs. He told supervisors at the meeting that ADMHS is striving to find a better balance by putting more effort into preventative and early intervention services.

Even with millions of dollars in new grant funding, continuing to improve services is going to cost the county a little extra money. In preliminary budget workshops, ADMHS officials asked for $12.2 million more in budget expansions, bringing the agency’s total budget to $92.2 million.

Combining that extra money with the grants and what’s projected to be an increase in funding from the Mental Health Services Act—an act passed in 2004 that provides money for mental health services from a 1 percent tax on anyone who makes more than $1 million a year—ADMHS has big plans. Those plans include a number of new programs that stakeholders identified as necessary services, such as teams who help a patient pre-crisis and also after they’re discharged from receiving care; more housing and care facilities; and a program geared specifically toward girls who were or are working in the sex trafficking industry.

So even though there’s still a long way to go, ADMHS is starting the battle. It’s not the first battle for change, but for those who have been around for many years, this is the most promising attempt yet. Annmarie Cameron of the Mental Wellness Center said she’s seen four different tries at transforming the system, but now it seems like everything is in the right place. There is new money and resources, hundreds of stakeholders are doing the work, and the Board of Supervisors is supportive, she said during the meeting. Now all everyone has to do is keep the momentum going.

“The times are ripe,” Cameron said. “Ask us to come back regularly and tell you where we are.”

Contact Staff Writer Camillia Lanham at clanham@santamariasun.com.