- ACHSA has had significant involvement in planning for national healthcare reform, including: advocacy directly with the Assembly Speaker’s office to ensure that California’s healthcare reform implementation legislation, AB1 X1, protected the future delivery of mental health services by the current county network of care; the development, in collaboration with the LA County Department of Mental Health (DMH), of the white paper, “The LA County Mental Health Network of Care: The Provider of Choice for Mental Health Services in the Era of Health Reform”; and the creation of a document entitled, “The Importance of Preserving California’s County Operated Mental Health Carve Out of Specialty Mental Health Services for Higher Needs Clients,” which was published by the National Council for Behavioral Health.
- ACHSA led County Department of Children and Family Service (DCFS) and DMH planning efforts toward the successful development of a groundbreaking comprehensive assessment system (known as MAT), endorsed by the County Board of Supervisors, which has allowed thousands of children entering the foster care system to have comprehensive assessments and related summaries of findings completed by ACHSA agencies.
- ACHSA advocacy led Probation to take the unprecedented action of supporting ACHSA’s request to fund a new Probation aftercare services pilot, using a portion of Probation’s Title IV-E Waiver carryover funds. This was the first time that County funds were to be used to specifically pay for residential aftercare services, to be provided by those agencies from whose programs the youth were transitioning.
- ACHSA was successful in its groundbreaking effort to secure Mental Health Services Act (MHSA) funding for ACHSA’s proposed new Community Integration Support (CIS) Program, the first time in the County MHSA funding process that funds were allocated for new outpatient type programs. The new CIS program will receive about $4 million a year to allow every Wellness Center program in the County to provide adjunct services, including medication management and case management, to adult clients, acting as a lifeline to facilitate consumers’ transition from Wellness Centers back into the community.
- ACHSA worked with DCFS to publish pioneering guidelines for the prevention of and response to allegations and incidents of abuse and neglect. These guidelines were provided to all DCFS and Probation group home providers in the County, along with the Department’s specific acknowledgement of ACHSA’s role in their development. Similar guidelines were also developed for Foster Family Agencies (FFAs). Both sets of guidelines were shared with the Board of Supervisors and their Deputies.
- ACHSA advocacy led to Probation making a number of significant changes to its Multi-Disciplinary Team (MDT) process in order to promote more significant provider involvement and an overall much improved process of developing a case/transition plan for each Probation youth in suitable placement. This included Probation’s agreement not to include a 5 to 6 month limit on discharge within time of placement and Probation’s adding an important criterion in determining if the MDT transition meeting date should be extended – i.e., whether or not the youth is prepared to transition back into the community.
- ACHSA was successful in getting the County Auditor-Controller’s office to consider and discuss ACHSA concerns related to its newly revised Handbook, and then to make a number of significant ACHSA recommended modifications to the Handbook, including having audits only be performed during normal business hours Monday through Friday, with unannounced visits occurring only when justified (as opposed to regularly without prior notice seven days a week), and agreeing to significantly expand the monetary threshold for required prior County approval of agency purchased capital asset equipment.
- ACHSA was able to address multiple issues related to member agency’s MHSA Prevention and Early Intervention (PEI) implementation. Among ACHSA’s accomplishments in this area were: obtaining and maintaining important DMH PEI training funds for ACHSA agencies; successfully advocating for DMH to formally evaluate agency sustainability of PEI practices through a joint evaluation of training and administrative costs, train-the trainer models, and practice cost effectiveness; the negotiation of the effective removal of the DMH cap on agency utilization of the Managing and Adaptive Practice (MAP) evidence based practice (EBP), which has become the preeminent EBP used; and successfully advocating for greater application of trauma based EBPs for adults.
- ACHSA has been a key player in the State/County Residentially Based Services (RBS) Reform Pilot Project, designed to test shortened timeframes for residential placement for foster and Probation youth by combining residential stabilization with community-based services. ACHSA was successful in getting the County to eliminate from the RBS contract the “10 month financial cliff” cap penalty, which had limited the payment of congregate care to 10 months and significantly penalized the agencies for any youth remaining in residential care beyond 10 months. ACHSA also was successful in getting an increased cost neutrality provision for the ACHSA RBS providers.
- ACHSA was heavily involved in addressing provider concerns related to the DMH implementation of its new Integrated Behavioral Health Information System (IBHIS). Among ACHSA’ accomplishments in this area were: delaying DMH’s timeline for IBHIS implementation to prevent manual data entry and address significant report generation issues before requiring providers to “go live”; convening special implementation meetings with DMH IT staff to assist ACHSA agencies in resolving operational issues before “go live” status; getting DMH to agree to set up a dedicated web portal to consolidate all IBHIS related information; and supporting DMH IT staff in preparing a tracking and rating system of each contract provider’s implementation status to assist agencies and facilitate phased in implementation across the county.
- ACHSA initiated a joint effort with the Auditor-Controller (A-C), DCFS and the CEO’s office to address concerns related to A-C audit reports of FFAs. The result was a better understanding by the County of the systemic challenges facing FFAs, along with revised audit findings which take into consideration only what can reasonably be expected of FFAs. Agreed upon guidelines were developed in the following areas: 1) criminal/child abuse clearances for persons visiting or residing in certified foster homes; 2) psychotropic medication authorizations; 3) initial medical/dental examinations; and 4) securing potentially dangerous household items.
- ACHSA worked with the County to address a systemic issue resulting in a number of Probation youth being placed in residential care with suspended Medi-Cal eligibility status. It was determined that the suspended status was the result of a code indicator being placed in the state Medi-Cal system which incorrectly identified Probation youth as incarcerated. As a result of ACHSA’s advocacy, the County implemented processes to identify and immediately resolve cases involving suspended Medi-Cal for Probation youth placed in residential care.
- ACHSA negotiated extremely significant changes to the DMH contract negotiation package, making life much easier for ACHSA contract agencies. Among the most significant changes negotiated were: the Department’s agreement to greatly reduce the number of copies that would be required to be submitted; the elimination of a very detailed and time consuming form asking for Subprogram Design information; and the elimination of another similarly time consuming form asking for Service Area Subprogram Budget information. ACHSA successfully argued that it made no sense for agencies to invest significant amounts of staff time in trying to capture data that was either very speculative to project or not of much use to the Department.
- ACHSA did an extensive cost analysis to determine provider costs of delivering wraparound services, which ultimately led to the County’s agreement to increase the DCFS wraparound case rate in year one of its new wraparound contracts from an initially proposed amount of $1,000 to $2,100. ACHSA’s extensive advocacy on this issue included numerous discussions with the DCFS Director and a meeting with the office of one of the LA County Supervisors.
- ACHSA advocacy with DMH’s Revenue Management Division led to the successful resolution of a State system processing error which inappropriately denied a large number of agency Medi-Cal claims. Contract agencies were allowed to replace claims as long as the client was Medi-Cal eligible for the month the service was delivered, and ACHSA was able to secure the replacement of claims for up to 12 months from the time the correction was made. This successful resolution saved ACHSA agencies from a tremendous loss of revenue due to improperly denied claims.
- ACHSA published best practice guidelines to address the significant problem of youth who run away from DCFS and Probation group homes. The guidelines describe in detail best practice strategies upon intake, upon placement, to prevent imminent runaways, for long term prevention, and upon a youth’s return to the group home. These guidelines were distributed to all DCFS and Probation group home providers in LA County, and both DCFS and Probation specifically acknowledged ACHSA for the development of the guidelines.