County Executive Officer*

Contractors provide eleven of sixteen services in the CSS Plan as of March 2007, with several other contractors pending approval. Agree with the finding. Response:

Contract Monitoring: HCA staff monitors contractor activities extensively; however, HCA has little or no direct contact with SMI/SED clients. HCA Staff relies on information recorded on charts/logs by the Care Coordinators. Disagree partially with the finding. Response: Health Care Agency (HCA) monitors contractor activities extensively. However, HCA receives information on the services provided by contractors through a number of processes that are in place, including contact with clients. Contract monitoring activities help to ensure the quality of services provided. Activities include, but are not limited to, receiving weekly reports on caseloads and new admissions, monitoring of outcome data, conducting client focus groups, on-site visits to contract programs, client satisfaction surveys, investigating and following up on concerns expressed by clients, development and provision of annual provider training, conducting secondary assessments of clients as needed and conducting outreach activities to individuals in the community that help to bring clients into these services. Training: Training by HCA staff and training contractors of County employees and

contractors providing MHSA services appears to be behind the schedule implied in the CSS plan. Agree with the finding. Response: MHSA training is behind the schedule proposed in the CSS Plan; however, all training included in the plan will be completed within the current MHSA planning cycle. Accuracy of Status Reports: A training contractor's records of what training had been

delivered do not match HCA's CSS Plan implementation status reports. HCA's status reports indicate that more training has been given than the contractor indicates. Agree with the finding. Response: 2 Exhibit 2 The training occurred in two parts, separated by up to two months and using separate sign-in sheets. Some participants were inadvertently counted twice. Some participants also signed- in for the same session on multiple sign-in sheets because they hold multiple professional licenses. This was done to ensure they receive appropriate education credits for participation, but it resulted in more sign-ins than actual participants. The steps being taken to correct the training records are outlined in the response to Recommendation R-4.

Multiple Contracts: Multiple programs/contractors may cause overlap in services. Response: Disagree with the finding. A process already exists to identify any duplication of enrollment by clients in multiple programs. If a duplication of enrollment occurs, HCA staff would work with the client to determine the appropriate program in which he or she should be enrolled. In some cases, overlap of programs and services is appropriate and is actually part of the program design. For example, the MHSA guidelines from the California Department of Mental Health acknowledge that transitional age youth may be served in both children's and adult programs. For this reason, the defined age range for children is 0-18, and for transitional age youth the range is 16-25. This ensures that transitional age youth can access the programs that best meet their needs as they approach adulthood.

Meetings with the Grand Jury: HCA's management requires contractors/providers to contact HCA before scheduling meetings with the Grand Jury. Response: Agree with the finding. HCA asked that contractors inform the agency of meetings scheduled with the Grand Jury. The request does not intend to limit the contractor's ability to meet with the Grand Jury. Instead, it serves to inform HCA that the meeting will take place.

CAT/PERT Programs: HCA has two CAT/PERT programs in place, Garden Grove and Westminster police department. Disagree with the finding. Response: There are currently three Psychiatric Emergency Response Teams (PERT) in place: Garden Grove, the City of Orange and Westminster. In addition, all law enforcement agencies in Orange County can access the services of the Crisis Assessment Team (CAT), and continuing outreach efforts to law enforcement regarding the availability of the CAT team has resulted in a significant increase in utilization of these services. The Orange County Chiefs of Police and Sheriff's Association has adopted a protocol instructing officers to contact the CAT team as their first response when they are presented with an adult mental health patient who may require an assessment. This protocol became effective August 2, 2006. Exhibit 2 Response to Recommendations