MHSOAC OCHCA MHSA Innovations By Keith Torkelson MS - The Big Roosevelt Report

 MHSOAC OCHCA MHSA Innovations By Keith Torkelson MS - The Big Roosevelt Report

Feature Image

Title – The Big Roosevelt Report - By Keith “Buster” Torkelson MS

 

Structured Temporal Reconciliation (STR)

Transactions – Intermediate Agency/Agencies

Here we address re-initiating our communication stream with the Mental Health Services Oversight & Accountability Commission 2022.

Last Reviewed: 20220325-F: DOW = Day of the Week

Communications up Front

20220318-F: To MHSOAC and Innovation Rep

MHSOAC Instructs
“Please contact MHSOAC staff for any questions regarding the MHSA”
Regards, OCHCA MHSA Innovations Processes
Innovation - Nev Jones (916) 445-8713
Nev.Jones@mhsoac.ca.gov

20220318-F: Greetings Nev Jones,

Based on the MHSOAC website it appears you are the go to person for concerns about local business with the Mental Health Services Act (MHSA) Innovations’ component (INN).  If so we here at Mentalation Solutions Group (MSG) will be sending you via e-mail our brief study that includes our concerns regarding Orange Counties' implementation of MHSA Innovations.  Our last contact with the Mental Health Services Oversight & Accountability Commission (MHSOAC) regarding MHSA Innovations was with Kevin Hoffman yet it looks like Mr. Hoffman has moved on. 

Key Staff Changes

We have requests, questions and concerns about the MHSA in Orange County.  In particular our interests lay with the MHSA Innovations Component implementation.  Normally we would go to the Director of HCA Behavioral Health Services (BHS) yet the position recently turned over and we have not had the opportunity to establish rapport with the new BHS director.  Hopefully you can help us and the MHSA move forward.  Have a nice weekend.  Thank you for your time and consideration, Keith “Buster” Torkelson MS (MSG’s Principal).

Mini-bios – List Form

We are preparing to sell our Mentalation Solutions Group (MSG) Housing Solutions Bundle (HSB) to various bodies including Orange County’s Behavioral Health Advisory Board (BHAB).  Typically when presenters sell in front of the BHAB they include a brief or Mini-bios.  Below is the outline for Buster’s Mini-bios.  As Buster’s one time boss Mark Refowitz said make an elevator speech: “Keep it short about one (1) minute”.

20220316-W: Timeline – Health & Human Services Centered Chronology
Buster’s Lived Experience – In Scope MHSA
Candidate - Keith “Buster” Torkelson MS

• Mentally Gifted Minor Program
• Eagle Scout
• Bachelors from UC Davis - Biology
• Master’s from UC Davis - Pathology
• Small Business owner – Call Centers
• OCHCA Trained – MHSA WET funded 160 hours in class
• Repurposed Master’s degree to encompass Social Pathology
• OCHCA MHSA Technological Needs Advisor
• OCHCA MHSA Innovations Advisor
• Authored Accountability MHSA Innovations Newsletter (AMIN)
• MHSOAC contributor on INN and PEI Regulations
• OCHCA Innovations Project Idea Training
• OCHCA Miscellaneous Quality Assurance jobs
• Contributions to Berkeley Training Manual
• Housing Analyst, Advocate, and Author

[INSERT MARK AND LOU]

MHSOAC Regulations Work

We applied our experience working on Technological Needs Policy and Procedures for MHSA funded consumer computers (Kiosks) at multiple OCHCA clinic sites to help out the MHSOAC with their Innovations and Prevention & Early Intervention Regulations.  We performed the work for the MHSOAC pro-bono.  We did it in exchange for return favors in the future.  In-addition Keith “Buster” Torkelson MS wanted his name listed in the final regulation as a contributing author.

MSGBase (Inception 2011) > Metadata >

 

Executive Summary – People & Things of Interest

We begin with our appendices.  In our appendix we include some contact information about the MHSOAC.  Keith “Buster” Torkelson began his affair with the Mental Health Services Act formally in 2009.  He built a working network both locally and affair centered on the MHSA.  Since 2009 he has witnessed dozens of administrator come and go.  For example, Mark Refowitz, Mary Hale, Clayton Chau (He came back), Kate Pavich, Casey Dorman, Kathleen Murray, Dr. Horner, Jeffery A Nagel just name a few locally.  He has also observed turnover at the MHSOAC level.  We document such MHSOAC changes in the appendix.  Overall we consider the OCHCA and MHSOAC administration bodies as not “Stable”.  Also in the appendix we share a sample of work Buster performed for the MHSOAC pro-bono.  It is interesting that when you are helping the MHSOAC they have no problem communicating with us.  We will or have discussed a smidgen ore on lived experience with MHSOAC communications later in this paper.

Links to Homeless Work Done

We here at Mentalation Solutions Group (MSG) have invested quite a bit of time documenting and in a few cases helping our local homeless.  The purpose of this study is to make more room for helping those in need of better housing with our Housing Solutions Bundle.  Below we include three (3) links including one to our Homeless Gallery as it is published on Google Blogger.  We here at MSG have spent a good deal of time, effort and money to capture the experiences of our local homeless.

Friday, October 30, 2020 [Exhaustive Homeless Gallery]

“We Walk quietly among our Homeless” Homeless Gallery - Orange County Centered by Keith “Buster” Torkelson and MSG (202010)

https://housingadvisoryboard.blogspot.com/2020/10/we-walk-quietly-among-our-homeless.html

Tuesday, February 18, 2020

20200219-W: Housing Advisory (HAB) – Statistic Study Centered About Homeless in Orange County CA

https://housingadvisoryboard.blogspot.com/2020/02/20200219-w-housing-advisory-hab.html

Tuesday, February 18, 2020 [Includes those who Died Too Young]

20200219-W-IB: HAB – Part II of II Statistic Study Centered About Homeless in Orange County CA By Keith Torkelson

https://housingadvisoryboard.blogspot.com/2020/02/20200219-w-ib-hab-part-ii-of-ii.html

Recommendation – No Approval

In this paper we discuss MSG’s a few reasons we think that the MHSOAC should not approve any MHSA Innovations Project Plans from the HCA submitted for 2021-2022.  Let the HCA massage their INN monies into existing projects.

Staffing Issues

There appear to be staffing issues in Health & Human Services.  Staff shortage may be one reason that the OCHCA as well as others are not able to communicate as well as they could pre-COVID.  Obviously face-to-face meetings and office hours took a big COVID associated hit.  Initially staffing issues are projected with the professional sector.  Yet now people are not pursuing careers in helping endeavors from top to bottom.  In this study we demonstrate some shortfalls with communications.

Concentration Psychosis

We diverge a bit to address psychosis because services to address psychosis appear to be problematic in that the county wants more money to build an infrastructure that should already be in place.  In addition psychosis management might cut into the funds we need to deliver our product line:  Housing Solutions Bundle (HSB).  We develop our HSB here only enough to put the idea on the table.

Populations - Work Done Wounded Warrior [Slideshow chronicling a BadBed)

We tracked a wounded warrior from 2012 till he died miserably in 2021 or for nine years.  This gave us the chance to review and touch up one of our publications.  We want to note that over half of our Human Services related publications are written with a specific audience in mind.  Our audiences are legal professionals, both probate and criminal, as well as teachers of the Health & Human Services.  Some of our papers are intensely complex due to the fact that when we pick a topic such as Care for Veterans there is so much qualitative information to be supported by quantitative data.  

 Wounded Warrior – BASALT – Presented by Keith Edward Torkelson, M.Sci. With MSG

https://ktork46.blogspot.com/2017/03/wounded-warrior-basalt-presented-by.html

Publication Stats for Wounded

When we discuss housing issues we get fewer readers that let’s say a report on PEACE.  To have 191 readers with housing and unmet needs is a good achievement.

Learning & Motivation

The motivation for Buster working up a Housing Related topic such as bed quality is that he lives in a dynamic environment that caters to Dying Old Men (DOMs).  When someone or something comes between him and his GoodBed he processes the problem by writing and publishing.  After this prime motivator he publishes for the benefit of others.  Our Housing Solutions Bundle (HSB) will generate much need learning.  For example we will uncover what really matters to each population in need.  Need for Substance Users differ a bit from let us say DOMs. 

Trading Favors Revisited

When Buster volunteered to help the MHSOAC write and rewrite their MHSA Innovation Regulation the deal was to trade favors.  In this report we ask for some favors.  The original MHSOAC people he worked with are long gone.  The current MHSOAC Rep for Innovation has yet to return Buster’s email.

Innovations Staff

We are discovering shortfalls with both local and state-level staff who work with MHSA Innovations.  Out of four (4) or so people we have called and or email none can read the email and respond intelligently.  We call this MHSA Communication Breakdown or MCB.

Cost-benefit studies

Locally at the MHSA Steering Committee Meetings (SCMs) stakeholders as well as committee member have repeatedly asked for cost-benefit studies.  MHSA related administrator indicted that these studies we too difficult and costly to perform.  We find that this hurdle is due in part to the fact that it is hard to monetize the benefits with the counties’ services and supports.  It looks like the OCHCA has a project that could determine the net Performance Earned Value of intervening about psychosis.  Without cost-benefit numbers it is hard to prove underperforming programs that should be cut.  From the consumer angle we talk with many individuals that say the county cut them sort.  The county almost solely reports on its’ successes.

Failure to Perform

In response to COVID related issue the county with a degree of urgency slashed some programs and budget.  These elements in a System of Care (SOC) were obviously deemed unnecessary.  From Buster’s perspective he was seeing many OCHCA MHSA programs and project that were failing to perform and thus unnecessary.

Stakeholders are concerned

It is 2022 and the MHSA stakeholders are concerned.  The stakeholders such as Behavioral Health Advisory Board (BHAB) members are not seeing “Nothing about us without us”.  Zoom meetings marginalized consumer stakeholders who did not have the resources and skill to attend Zoom meetings.  The OCHCA mentions this forum or survey including consumers just to cover home plate.  The time tested Steering Committee Infrastructure has disintegrated.  At the upcoming Meeting of the Minds (MOMs) on April 15, 2022 the county table should have a survey to collecting Satisfaction with the OCHCA’s role with the MHSA and MHSA programs.

Early Innovations Rounds

Buster has been involved with MHSA Innovations from the start.  The first round of Innovations he tracked and used as a learning tool.  In subsequent INN rounds he sat on the OCHCA Innovations Advisory Committee (IAC).  For one round the IAC worked vetting all project submitted per round.  In 2014 Buster collected and inventoried all Assessment Tools the county was using with their Innovations projects.  He submitted the results to the county to the MHSOAC and we published them online.

MSGBase > Metadata >

New Projects Being Sold

As we will address later in the paper a “Hold” was placed by the county for new INN Project Idea (IPI) submission.  The county has not made it clear that the “Hold” has been lifted.  We are getting close to going to press.  Perfect timing we just received the documentation for the upcoming Innovation Public Hearing.  The hearing is scheduled for Wednesday, April 13, 2022

From 9:00 a.m. – 11:15 a.m.  Both Sharon Ishikawa and Flor Yousefian Tehrani will address: Opening Remarks and Overview of the Innovations Project Proposals for forty (40) minutes.  This confirms that Sharon and Flor are the go to people when it comes to OCHCA MHSA Innovations.  Neither Sharon nor Flor have been able to communicate with us as well as their predecessors.  How can we have new Innovations Project Ideas (IPIs) when the process is on “Hold”?

New Projects Nature

Next week, April 13, 2022, the county will be addressing two (2) Innovation Project Ideas (IPIs) at a special public hearing meeting.  This is good because it gives us a bit more time to impress upon the county and the MHSOAC the concerns we outline in this paper.

1. Improving the Early Identification of Youth at Clinical High Risk for Psychosis and Increasing Access to Care Innovation Proposal

[Recommend Against]

2. Examining Whether Integrating Early Intervention Services into a Specialized Court Improves the Well-Being of Justice Involved Young Adult Men: A Randomized Control Trial

[Out of Scope]

3. Orange County Innovation Community Program Planning

[This effort may clear things up some]

Direct to MHSOAC

In preparation for severe shortage with staffing in Health & Human Services (HHS) we recommend that the MHSOAC position itself to handle more of the work in MHSA Innovation previously delegated to each county.  In other words prepare for direct submissions of INN Project Ideas (IPIs) from those submitting the IPIs.  This would improve the efficiency of the MHSA Innovations process.  Another route would be to cut out the middle thing.  In this case it would be eliminate the MHSOAC’s role as well as the frustrations in causes with plan approvals.  It would be an Innovation if the MHSOAC graduates the counties while picking up a stronger role in customer service, product evaluation and quality control.  Included with product evaluation would be cost-benefit studies.

Communicating with the MHSOAC

Near the end of the report we include information about communicating with the MHSOAC.  Circa 2010-2014 we were satisfied with the ability of the MHSOAC to communicate directly with us here at Mentalation Solutions Group.  We will save our current impressions about the MHSOAC for later in this report.

Hold & Selective Hold

This is the most important portion of this report.  The OCHCA put a “Hold” on the Innovation Project Idea (IPI) process.  They shared this position on one of their Internet Webpages.  We are not certain if the INN Regulations as authored by the MHSOAC permit putting a “Hold” in the INN process.  It would be like they put a hold on submitting their MHSA 3 Year Plan just on a much smaller scale.  The “Hold” has been or was in place for more than two years.  The interesting is they have covered up the “Hold” by erasing the message and placing a re-direct on the old “Hold” page.  Now they get to be less accountable about their “Hold”.  We blew it be not capturing the “Hold” page with PrintScreen.

Figure – OCHCA Innovation Forum Homepage Message

As late as March 15, 2022

OCHCA INN Centered Observations (x 12)

1. “Hold on INN submission process”
2. Distractions such PADs and Psychosis
3. Existing psychosis projects have failed to deliver
4. Failing to listen to a broad range of stakeholders
5. Ignoring Innovations needed with Housing
6. Making big things of small things such as PADs
7. Not responding to communications
8. Our INN Project Idea might be better delivered as a PEI Program
9. Picking and choosing stakeholders
10. Potential selective “Hold” New Project Developments
11. Staffing problems including in administration
12. Too distracted about COVID-19 (Corona & Dr. Chau)

Impact of MHSOAC saying no

A few years back the MHSOAC shut down enough OCHCA Innovation Plans that the OCHCA panicked a bit.  In this paper we discuss some of the OCHCA reactions to having their hand slapped.  Aside, we wonder why the MHSOAC still needs to be involved.  By now they should have educated the counties on getting Innovations correct.

Requirements and Specifications

Last Reviewed: 20220408-F:

Impact of MHSOAC Saying NO to the OCHCA!

We here at Mentalation Solutions Group (MSG) have been working with Orange County Health Care Agency (HCA) Mental Health Service Act (MHSA) efforts since 2009.  Our principal Keith Torkelson MS was assigned HCA Technological Needs while waiting while the HCA formed the MHSA Innovation Advisory Committee (IAC) (See Mini-bios).  Religiously Mr. Torkelson attended HCA MHSA Steering Committee Meetings (SCMs).  More often than not the Steering Committee (SC) had at least one action item to vote on the approval of budgets, plans and projects.  In over ten years the SC failed to vote down something.  Then sometime in the last three years something remarkable occurred.  The Mental Health Services Oversight & Accountability Commission (MHSOAC) vetoed over half of the HCA’s Innovations (INNs) project idea proposal plans.  We knew that at some point Mentalation Solutions Group (MSG) as an MHSA stakeholder would reach out to the MHSOAC for assistance with the HCA’s INN project idea submission process.  Submissions seem to be on “Hold” yet new ideas are being presented.  This report discusses intelligence that Mr. Torkelson feels might benefit the MHSOAC.  In addition we have a few MHSA related questions and a few recommendations.

No Viable INN Submission Route Found – Unexpected Hurdle

We here at Mentalation Solutions Group (MSG) have wished to write the Mental Health Services Oversight & Accountability Commission (MHSOAC) for quite some time.  MSG’s principal is Keith “Buster” Torkelson MS.  After going the distance as an advisor on Orange Counties’ (HCA)  Mental Health Services Act (MHSA) Innovations Advisory Committee (IAC) Buster decided to author some Innovations Project Ideas (IPIs) of his own.  All of his ideas have been centered about Housing and Housing Solutions.  He knew well the process as it was orchestrated from circa 2014-2018.  As he readied our submission he was directed to the HCA Innovation Forum.  In the forum he discovered substantial revisions were made to the INN process.  Here is what we found in effect with the forum.  If you search using the link below you will see the “Hold” message is still in effect.

Last Link Check – March 18, 2022 (F) Returns “Page not found”.  For both accountability and transparency we know that when you remove information from the web you state what was removed and why it was removed.  Now at the forum site there is no notation that the Hold existed.  We were hoping it was going to say the hold had ended and how to go about post-hold Innovations activities.  Looks like now the HCA doesn’t have to be transparent or accountable for their INN “Hold”.  There was a good deal of information derived interactively in the Forum all lost now.  We can see if you were new to the forum it would be rather complex.  Someone said well this is too complex and mostly out of scope: Get rid of it!

New Search Thread Initiated “OCHCA MHSA Innovations submission process”

Hopefully the powers that be that deleted the forum patched up the Innovations process.  We will start a new search thread to see if we can hit upon the new and improve OCHCA Innovations processes.

See Appendix for Updated List of online hits for “OCHCA MHSA Innovations submission process”

FAQ

Did the MHSOAC INN Regulations permit placing INN Project Idea submissions on “Hold”?

OCHCA INN Forum Webpage > Link >

https://www.ochealthcareagency.com/innovations/forum/

Hold Message Copied Over

Unfortunately we did not see deleting the forum coming.  If we though that there was a potential for cover-up we would have taken a screenshot of the forums home page.  The re-direct page should include who in authority ordered deletion of the forum.  Yet we did catch the hold message as it appeared on the forum home page.

Figure – OCHCA Innovation Forum Homepage Message

As late as March 15, 2022

“Status Updates” – Selective “Hold”

We assume that a good way to update the status on the “Hold” would be via the forum page where we find the “Hold” message.  Now with the forum deleted the OCHCA could address the hold status on the new re-direct page.  If the status update clearing the “Hold” happened elsewhere we have not heard anywhere.  Yet we did find indications that new MHSA INN ideas such as Psychiatric Advanced Directives (PADs) are being worked on by the HCA.

Note: MHSA INN Regulations

Because we wanted our Innovations Project Idea to go through we decided after Buster finished his term with the OCHCA Innovation Advisory Committee (and workgroup) he should help out the MHSOAC.  Back in 2014 he helped refining the MHSOAC Innovations Regulations.  Make note that the MHSOAC did not adopt any of his suggestions on policy such as limiting all Innovations to three (3) years and limiting budgets to $1,000,000 per year.  Later in 2016 he examined the MHSOAC Prevention & Early Intervention Regulations.  

Ethical Concern

We here at MSG are not certain if the MHSOAC Innovations Regulations permit a county to stop accepting INN Project Idea submissions.

OCHCA (HCA) - Communication Breakdown

We here at MSG waited patiently for the “Hold” to be taken down for over two (2) years.  We sent emails and made phone calls the principals in our HCA network.  One administrator to a group indicated that the OCHCA lacks the staff to manage communications properly.  We messaged both the MHSA Coordinator and the MHSA Innovations Coordinator.  They did not pick up the phone or respond to emails.  We waited patiently.  We hoped the November 28, 2019 “Hold” would be replaced with the: Who, how and when to submit an Innovation Project Idea (IPI).

Impact #2 of MHSOAC Says to the OCHCA!

MHSOAC Says No!

Remember since there has not been in-person for quite some time that many communications come through “A Wire”.  We heard through a wire at a MHSA Steering Committee Meeting (SCM) that the MHSOAC had turned down over half of the projects that the HCA submitted in an Innovation (INN) round or cycle.  This bothered the OCHCA (HCA) so greatly that they paid to have people go up to Sacramento presumably to learn from the MHSOAC how to get things right.  In other words the OCHCA wished to learn from the MHSOAC how to submit project ideas that will be approved.  That is part of our purpose for this study: How to get our Innovations Project Idea approved, perhaps directly to the MHSOAC.  We have discovered how fragile and unreliable the HCA INN process is.

Seeking out a higher authority – MHSOAC

Just like the HCA we here at MSG need help from the MHSOAC.

For Innovation see Nev Jones @ (916) 445-8713 or

Nev.Jones@mhsoac.ca.gov

FYI – We include some MHSOAC and related contacts in the Appendix – MHSOAC Page

Why are we here at MSG invested in MHSA-Innovation?

The Mental Health Services Act (MHSA) was founded on a principle of better engaging the consumer: “Nothing about us without us”.  Of all of the MHSA Components Innovations (INN) was to permit consumers to solve issues for consumers (peer-to-peer).  It is fine that MHSA Components Prevention & Early Intervention (PEI) and Technological Needs (TNs) be delivered by people without diagnoses (including providers) yet we recommend only approving INN projects written by consumers and family members.  This is Innovative of itself.

Audit and Program Culling

The current INN projects we see in the works have provider written all over them.  Non-consumer providers should stay with the other MHSA components.  This would help components such as Prevention & Early Intervention flux more by getting rid of poor performing programs.  Due to improper inter-program measurement pretty much any PEI Program implemented is considered a success.  We suggest it prudent to audit the PEI programs and cut away ¼.  This would open up PEI happenstance for better solutions.

Seriously Unmet Needs

If one listens to consumers and questions them a bit you will find that one if not thee major concern is meeting their unmet Housing Needs.  If the provider approaches to remedying our serious housing problems in Orange County are effective (more than ten years trying) then we would not have the current housing crisis.  COVID has marginalized Orange County’s housing problems.  We measure this partially with the OCHCA Directors message in the What’s Up Newsletter.  We feel that here in “The OC” as well as any sizable urban area that Housing will best be solved primarily by the consumers: For the consumers.  The reason we here at MSG are vested in MHSA Innovations is that it is supposed to be a user-friendly route for consumers to engage creating solutions for Behavioral Health.  We are working on an extension to Certified Peer Support Specialists (CPSSs).  We call these well trained consumers Certified Peer Housing Specialists (CPHSs).

Suggestion – Removing Middle-people

It might be best to take out the middle-people and have stakeholders mostly consumers submit project ideas to the MHSOAC directly.  Now!  That would be an Innovation in and of its’ self.  Actually we could save a good deal of money and time with the Direct Submission Method (DSM).

Selective Hold

Even though we queried several times across several different Health Care Agency (HCA) administrators the: How, when and what to submit an MHSA Innovations Project Idea (IPI) for more than a year yet we have yet to receive the personalized responses to which we are accustomed.  Thus we believed that the “HOLD” on submissions remains in effect.  By spring quarter 2021 HCA COVID driven reactions were in full gear.  The county eliminated in person oversight meetings such as the monthly MHSA Steering Committee Meeting (SCM).  The county restricted in person office hours with the administrators.  In a zoom Behavioral Health Advisory Board (BHAB) meeting a small team was permitted to present on Psychiatric Advanced Directives (PADs).  The PAD project was being promoted as an Innovation project.  On one hand Buster liked the PAD idea because he believes in advanced planning.  On the other, with PADs something is fishy in the State of Denmark because we classify PADs as a post-hold effort.

Communication Breakdown

MSG returned to the forum site just to observe that new idea submissions appear to remain on “Hold”.  Buster wanted to discuss this fluke with Admin yet could not get time in office hours.  Again, most likely HCA communication restrictions are in part due to COVID.  Buster wrote to the powers that be such as the HCA MHSA Coordinator and could never get a response.  Buster made phone calls and the lines were not being picked up.  He left messages and he received no call backs.  So we renewed are effort to share our frustrations and work through the MHSOAC.  The MHSOAC has a good track record of getting back to us.  In the meantime we wait for the Hold status to be lifted.  As we discussed earlier the hold message is gone from the forum website yet there are no instructions about how to get on track.

Pre-hold Projects V New Projects

Lets’ assume that any Innovations projects that the OCHCA (HCA) is working with were submitted before their Innovation (INN) project “Hold” was in place.  We would really like to know when the “Hold” will be lifted and new projects accepted.  Even though the Hold message has been deleted there are details about HCA Mental Health Services Act (MHSA) INN post-hold.

Need to know:

For MSG and other stakeholders alike: When will Innovations (INN) open up to the full-spectrum of contributors, what format should we work with, and what are the route(s) to submit new INN Projects? 

New Project Being Sold – Time Sensitive

Here we address the time sensitivity of our report here.  The project below was presented at the monthly OCHCA Behavioral Health Advisory Board (BHAB) related Substance Use Disorder (SUD) System of Care (SOC) Zoom Meeting early this March (2022).  We hope we caught it in time. 

We recommend the MHSOAC not approve “Improving the Early Identification of Youth and Clinical High Risk for Psychosis and Increasing Access to Care” in any incarnation (See reasoning below).

Metadata >

10_Psychosis_INN_CHR_22031501_MHSOAC_Notes

Figure – “Psychosis” Presentation for OCHCA

Reasoning - Intelligence – Time Sensitive

• The psychosis project is being presented while the Innovation process is on “Hold”
• Housing has a higher priority than diagnostics
• It fails to address a strong linkage between housing and prodromal symptoms including those of psychosis
• It very likely supplants existing services and supports such as First Onset of Psychosis
• Limits stakeholder participation
• The project is too big as measured by yearly budget requests of over $2,000,000
• Very likely better fit for Prevention & Early Intervention funding
• What they want to learn should have already been learned through prior efforts addressing psychosis

Innovation Process Timelines

We have other concerns with the “psychosis” presentation.  Note our local time tested MHSA Steering Committee (SCM) process has been supplanted.  Since January 2021 our new and improved Behavioral Health Advisory Board (BHAB) is gradually addressing what our SCM did.  Historically, most presenters to the SCM shared exactly where their products lay in the Standardized Project Development Timeline (SPDT).  Below we include typical INN Project Idea timing stages.  The two “psychosis” presenters Jason & Theresa alluded to a Request for Interest (RFI).  If the “psychosis” project has already passed the MHSOAC Approval Stage then our recommendation about this project is mute.  We found one thing peculiar about their presentation.  The presenters came across as if they own or will own the contract.  In other words it is as if they responded to a Request for Proposal (RFP) and were awarded the contract.

Figure - MHSA Innovation Process Timeline – New Projects

Link >

https://www.smchealth.org/sites/main/files/file-attachments/inn_timeline.pdf?1525134146

New Projects
Community Input (Three-Year Planning)
Steering Cmtee
Innovation Ideas and. Prioritization

Metadata >

01_Assess_MHSA_SCM_Value_17110602_Tool V2022

Innovation Project Discovery - The Divide – Pre-existing V New Projects

We here at Mentalation Solutions Group (MSG) have been trying to determine as centered about the OCHCA’s MHSA INN project idea “Hold”: Where do existing submissions end and new submissions begin?  It took us awhile yet we finally found a good resource addressing many not all OCHCA INN Projects approved by the MHSOAC.

First Round
Figure – OCHCA INN Plan Work
Began 2010

Query > “MHSOAC Innovations Approvals”

We are looking for a list of OCHCA Innovations Plans that went through the MHSOAC, funded and implemented.  We know that in the list above created by Mentalation Solutions Group (MSG) that several of the work plans were completed.

Distractions

It is likely that any Innovations plans approved after May 23, 2019 are new ideas.  In addition any idea in the works after May 23, 2019 would be a new submission.  If this is true the OCHCA failed to inform all of its’ pre-existing stakeholders that the “Hold” was off.   Two projects that appear to be new are: Psychiatric Advance Directives (PADs) and Improving the Early Identification of Youth at Clinical High Risk for Psychosis and Increasing Access to Care (CHR).  We here at Mentalation Solutions Group (MSG) feel that anything that does not address Housing is a distraction.  We find that the PADs do have a smidgen of Housing value. 

20220405-TU:

Query “Submitting a MHSA Innovations Plan to the OCHCA”

Hit in Scope

You would figure about now if you apply the query above that we would hit on what we need to know for moving forward with our Housing Solutions Bundle (HSB).  The PDF document reference below does not appear to be maintained.  In other words the “Idea Generation Website” has not been noticeably updated since Jun 18, 2018.  The sample project included is the Early Psychosis (EP) Collaborative Evaluation project.  We’ve visited this resource (page) at least 2 times in 2022.  Our last visit was 3/13/22.

Metadata

Orange County Health Care Agency Behavioral Health Services
https://www.ochealthinfo.com/sites/hca/files/import/data/files/80073.pdf
Jun 18, 2018 - MHSA Innovation (INN) Projects

MHSOAC Stability

20220325-F: Note: After one (1) week the email we sent to Nev the Innovation Rep with the MHSOAC still has not garnered a response.  Years ago Buster performed work for the MHSOAC pro-bono.  He worked both on the MHSA Innovation Assessment Register and Innovations Regulations.  The deal was that if and when he needed assistance he could get it.  Unfortunately most if not all of his MHSOAC contacts have retired or moved on.  It is April 5, 2022 and we still have not heard from the go to MHSOAC Innovations person “Nev”.

Metadata > Summary included in the Appendix

Inventorying OCHCA Project

At the link below we found a list of the projects that were approved by the MHSOAC.  It conflicts a little with reality.  For “The OC” round 1 of the Innovations projects implemented before 2014 are not listed.  The information appears to be owned by State Of California Department Of Health Care Services Health And Human Services Agency.  It addressed the term FY 2019/20.  If looks like the Innovation list only addresses projects that would spend money circa 2019/20.  Step forward appears to be the oldest project.

Metadata > OCHCA Innovations

https://www.ochealthinfo.com/sites/hca/files/import/data/files/119403.pdf

MSGBase > Metadata >

Note > Page 19 - From the document above we extracted the following

Figure – An Inventory

OCHCA MHSA INN Projects Approved by the MHSOAC

Project Inventories (Continued)

We have yet to find a complete OCHCA MHSA Innovations (INN) project inventory that includes:  Projects submitted, project accepted locally, projects planned, projects submitted to the MHSOAC, MHSOAC determinations, the measureable outcomes and products, cost-benefit summaries of each project.  Early on (2009) we here at MSG fancied reviewing the Innovation’s Projects Final Reports (IFRs).  As well as The OC we looked into other counties such as Stanislaus.  We found the ones published locally on a county server were easier to access than the ones shared through the MHSOAC.  Generating and sharing thorough INN related inventories can aide in many ways including helping those submitting ideas work up their idea.

Request

If possible can the MHSOAC provide with a link that includes comprehensive INN related inventories by county?

Impression V Actual

In 2012 Buster with the Orange County Health Care Agency’s (HCA’s) newly formed Innovation Advisory Committee (IAC) was asked to Vet some 22 Innovation (INN) Project Ideas.  Of the original 22 only 14 were pre-screened as feasible.  After the IAC’s voting day we here at Mentalation Solutions Group (MSG) had no idea of how many of the 14 were picked up as “Viable” by the OCHCA for plan development.  We thought that number would be associated with how much INN money the county had to spend.  If the information in the Figure above – OCHCA MHSA INN Projects Approved by the MHSOAC is correct between 2014 and 2019 only three from OC’s original round we approved by the MHSOAC.

New Gap Emerges – Innovation Gap

In all it looks like at least seven (7) HCA MHSA INN plans have been approved by the MHSOAC.  We had no idea that the rate of conversion from submitted ideas to MHSOAC approved projects was so low.  We now see in part why the HCA is squirming and stressing a bit with the INNs Component.  It takes a good deal of work to write the INN Project Idea Plans (IPIs).  Difficulty is no cause to cut away many of our local stakeholders including consumer and family member stakeholders.  With respect to INNs and other MHSA Components we see a new emerging Gap has formed roughly since the “INN Hold” was enacted.  Since we signed on the MHSA driven “Good Fight” communication at multiple levels has broken down.

Stakeholders indicate Concern

A few years back the MHSOAC found cause to slap the hand of our Orange County Health Care Agency (HCA) when the HCA submitted too many non-viable and invalid Mental Health Services Act (MHSA) Innovations’ Project Idea (IPIs) plans.  We feel it might be wise the MHSOAC guide them again.  Several of us stakeholders such as those with the relatively newly formed Behavioral Health Advisory Board (BHAB) are concerned with the marginalization of consumer and family members.  Technology driven Zoom meetings have too few consumer stakeholders attending.  Some call this feature part of the “Technology Gap”.

Figure – OCHCA Early work with Innovations

Communication Effort Revisited

Basically believing that Innovation Project Idea (IPI) submissions were placed on “Hold” on November 28, 2019 we paused a few months to puzzle MSGs’ post-hold efforts including sales.  On February 24, 2020 we attended an MHSA Steering Committee Meeting (SCM) that largely dealt with the HCA MHSA Innovation’s Component (INN).  We selected the go to people for addressing our concerns with MHSA Innovation processes were Sharon Ishikawa the MHSA Coordinator and Flor Yousefian Tehrani the MHSA INN Manager.  As we will demonstrate we sent forward communications to both.  It is March 25, 2022 and we still have no responses from either.  Just recently we tried Annette Mugrditchian, Director of OCHCA Operations.  We here at Mentalation Solutions Group (MSG) always favored Annette because Buster’s HCA Technological Needs supervisor Kathleen Murray indicated that Annette does good work.  Annette has not responded either.  In public various administrators have said the communication breakdown is in part due to staffing concerns.  A staff that cannot communicate appropriately while working in a Sociological arena!  Yes, we see that would be a problem.  We had grown accustomed that those in our OCHCA Network communicated well.

MHSA Innovation (INN) Projects

It appears as if on June 18, 2018 the Orange County Health Care Agency (HCA) Behavioral Health Services (BHS) was working with an Innovations project called Early Psychosis (EP) Collaborative Evaluation.  This project would be considered an existing project before “The Hold”.  Records indicate that project was renamed Statewide Early Psychosis Learning Health Care Collaboration Network.  The MHSOAC approved it on 12/17/2018.  We allude to this project because we will address it later with Supplanting. 

Metadata > June 18, 2018

https://www.ochealthinfo.com/sites/hca/files/import/data/files/80073.pdf

Web-based Idea Generation

Back around 2018 the HCA changed the manner for submitting MHSA Innovations Ideas.  They launched what they call the “INN Idea Generation website launched May 2018”.  The site says it “allows for ongoing submission of project ideas”.  The HCA also supported their web-based Innovations Forum.  Sometime around November 2019 the following message appeared on the HCA’s “Forum” site.  Note: During March 2022 the forum was pulled and replaced with a redirect page. 

Original Message

[“November 28, 2019 submissions placed on hold”]

Data Outcome Advisory Committee and Work Group

Early Warning Assessments

Back in 2010 Buster was invited by his then HCA supervisor Kathleen Murray to sit on the Data Outcomes Advisory Committee (DOAC).  When they took up resolving issues presented to Child and Youth Services (CYS) the committee determined an originally authored screening tool was in order.  Because at the time a strengths polarity was considered a promising practice the DOAC decided to go with a county authored instrument measuring “Resilience”.  The author of the county tool was Dr. Janel Alberts.  For MSG Buster wrote a comparative Resilience Scale.  We tested them in parallel and both yielded very similar results (scores).  Our hope was that the county partner with the Orange County Department of Education (OCDE) and assess all public school kids once per year.  This would include any kids with prodromal signs of psychosis.

Failure to Perform

The county has a few programs in place to address both kids and psychosis.  The fact that the HCA is still seeking new approaches as this point in a sign of failure.  County employees and contractor employees are assigned disparate tasks.  As Dr. Casey Dorman (HCA-Psychologist) said before his retirement:  Our offices, divisions, administrators Etc. are operating in “Vacuums”.  If I could do anything right before retirement that would be vastly improve intra-county agency communication.  Well Early Psychosis (EP) Collaborative Evaluation was approved and what can we say: People in the know are still writing bad programs using the strong MHSA programming language.  We call the MHSA the Steinberg Programming Language (SPL).  Incidentally, we found UC Davis is a collaborative lead on the EP project.  Buster takes a little more time when UCD comes up because he earned his BS and MS from UCD – Go Aggies!

[We are determining if the new psychosis project idea is associated with the 2018 EP project.  It is very likely the new psychosis project is being developed while for the marginalized the HCA Innovations process in on HOLD.  As of March 25, 2022 we still cannot get an update on the HOLD]

CalMHSA

Early Psychosis implies intervention at a Preventative stage or level.  If the county were to implement their Early Psychosis (EP) Collaborative Evaluation the best fitting MHSA Component would be Prevention & Early Intervention (PEI).  EP project implies a statewide collaboration.  We know statewide projects are best managed by CalMHSA.  Incidentally, we feel that in a manner CalMHSA is letting the state down.  CalMHSA promises to resolve Stigma & Discrimination, Student Mental Health, and Suicide Prevention have not come to fruition. 

EP – Cost-effectiveness

Outcome measures and sharing efficiently was to be built into ALL MHSA programs and projects.  So why would you need to spend so much money to assess the cost-effectiveness programs such as those dealing with psychosis.

Studying Mary Hale’s Tenure

Mary Hale MS took over as the OCHCA BHS Director back around February 2017 after a successful five year run by Mark Refowitz.  Many times at the monthly MHSA Steering Committee Meetings (SCMs) members would ask Mary for cost-benefit studies for her MHSA programs.  Repeatedly Mary said they are very hard to do and we would have to hire consultants.  The system of care is expanding and it will be prudent to address cost-benefit analyses.  You could just close it all down and start again.

Mark Says – “I Know You Will Get This Right”

The goal of the EP project is to: “Goal: Assess program and cost-effectiveness of EP programs across the state”. OK fine so spend: “Estimated Budget: OC will request up to $2.5M”.  You had better get this right as to set a standard for all future comparisons.  We here in “The OC” are facing a huge audit challenge.  After we have produced some odd 100 cost-benefit studies this project may prove its’ concept.  It is not so much to address psychosis as it is to create an audit standard.  This audit if done correctly should be the standard of excellence and applied in some shape way or form to not only all local MHSA endeavors yet statewide.

FYI - Action Item

“Approve plan to join Statewide Early Psychosis Learning Health Care Network Innovation Plan”

Back to Communications

[We have attempted several times to contact the OCHCA “INN Team” using their prescribed routes as listed below.  See sample communication below]

Metadata >

SCR_OCHCA_BHS_MHSA_Sharon_Ishikawa_21042103_Notes V2022]

Sharon Ishikawa was the last known OCHCA MHSA Coordinator.  We here at Mentalation Solutions Group (MSG) lack the resources to grow partnerships with all OCHCA administrators.  Our go to person was Dr. Jeff Nagel yet he moved on back in December 2021.  We never thought we would have the need to transact with Sharon.  We just monitored her activities.  At this point it is either go with the MHSOAC or link with the new HCA Deputy Director.

Web-based Contact Information

“Contact the INN Team!”

The last time we tried to contact the INN team was March 25, 2022.  Normally we would pick up the phone and call.  Yet it is probably not a good time to distract and just finish our report here.

FYI – Pertains to OCHCA

Hyperlinks are not active

“Visit the Community Forum page and check the Calendar for upcoming events!”

Actual Message Sent to Group

You’re Message

1220PM: 20210104-M:
Greetings Doctors FY Tehrani, S Ishikawa and J Nagel]
Repeated 20210225-TH

Last time we checked as of “November 28, 2019 the idea submission process was placed on hold in order to focus on further review of the existing idea submissions”.

Are you accepting OCHCA MHSA Innovations’ Idea submissions at this time?  If so how do we submit and in what level of detail.  We have reviewed the OCHCA MHSA Innovation Forum and the ideas shared there appear to be brief and in a bit different format than priors INN submissions.  Should we follow the format as demonstrated in the INN forum?  We know that Corona has tied up substantial resources.  Yet our INN idea addressing housing issues and fixes is still a priority.  Thank you for your time and consideration.  Keith “Buster” Torkelson MS. (Sales and Marketing stages)

OCHCA MHSA Innovations Process

Basically the scheme was: The Innovation Project Idea (IPI) submitter works up their idea while following the HCA’s standardized format.  Next, you submit your idea usually via email to the HCA.  The ideas in a round were pooled and the HCA INN staff follows the steps in the table below.  After attempting for more than a year we here at Mentalation Solutions Group (MSG) have yet to garner a concrete instruction to whom to submit our IPI, when to submit our IPI, and in what format.

MSGBase > Metadata > 9/13/2019

Online Research

About this time we would like to search “OCHCA MHSA Innovations Project Idea Submissions” to obtain some up to date and accurate information on what to do next.  The benefit of this “Hold” is that we have been looking into finding other funding such as Prevention & Early Intervention (PEI) monies.  In the long run our Housing Solutions Bundle (HSB) is best sustained as a PEI program.

FYI > Website Review Process Preliminary Review

Below is a table of what the OCHCA indicates are the “Roles of Innovations (INN) Staff”. We break things down into Tasks.  Again the word on the streets is the OCHCA is having staffing problems.  Just a heads up that the MHSOAC might be asked to step up, level statewide resources and do more of the work that the county is assigned.

Table – Roles of Innovations Staff

If Only 1 or 2 - Role in the Mental Health System

Mentalation Solutions Group’s (MSG’s) primary roles in the Mental Health System are as follows.  Our foremost effort is to act in the capacity of External Quality Review.  Most of our work is associated with CMS.  Buster’s Behavioral Health Doctor (BHD) recognizes Buster as a Housing Advocate.  Much of our work is supported with Quantitative Assessment.  We deliver on our Performance Earned Value (PEV) and on our Health Related Engagement (HRE) products.  We have developed our Structured Temporal Reconciliation approach into a promising practice.  Buster has taken his degree in Pathology and reworked it on his way to mastering Social Pathology.  MSG is family driven.

Past Experience

Keith “Buster” Torkelson MS has submitted at least three (3) Innovations Project Ideas.  All were turned down at the county level.  At least one (1) dealt with Housing issues.  The issues that Buster was working to fix still plague Orange County.  Back in 2014 we shared our takes on MHSA Innovations in our Innovation Component Minute (ICM) publications.  While we wait for a green light from the MHSOAC and or the OCHCA to submit our current idea we will review some of our minutes as published on Google Blogger.  As far as the roles listed in the table below we here at MSG identify as other: Stakeholder and Advocate.  Our primary concern is housing the disadvantaged including the homeless.

Table – Legacy OCHCA Innovations Idea Form

MSGBase > Metadata for Innovation Component Minute

Learning

You might wonder what learning our Housing Solutions Bundle (HSB) project will deliver.  We will discover once and forall the weight that Housing Quality and Bed Quality play in human health including behavioral health and substance use disorder.  We will track cost-benefit with respect to Housing those in the most dire need.  We will begin to formally inventory the beds in existence.  One bed at a time we will discover the nature of GoodBeds and BadBeds,

Networking - Annette and Veronica

Yesterday March 31, 2022 Buster attended a Be Well related initiative meeting.  Our new Behavioral Health Director, Veronica Kelley, shared in-person for the better part of an hour.  Dr. Kelley asked for questions yet Buster was not positioned to ask germane questions.  Particularly when we have questions to ask that the general attendee need not hear.  In the same administrative hierarchy that now has Dr. Kelley near the top the Operation’s Manager Annette is near the top.  Who is the HCA top dog?  Dr. Clayton Lon Chau.  We mentioned Annette earlier on.  We may have detected some animosity between Dr. Kelley and Annette.  We had emailed Annette with a few questions yet have yet to receive an answer.  One question was: What is Dr. Kelley’s email?  At the Be Well meeting Dr. Kelley shared it with all in attendance.  So at least we completed one item in our MHSA Spring Quarter to do list.

Concentration Psychosis – Failure to Deliver on Time

Now it looks a psychosis project may be competing with our funding.  To keep it short remedying psychosis was funded here in “The OC” nearly from the inception of our MHSA.  The HCA has a Full Service Partnership (FSP) to address the first onset of psychosis.  If the agency is asking for more money to remedy psychosis this would mark that the programs in existence are failing.  They have failed to bring into fruition the deliverables they promised.  In this case that is substantially solving psychosis and surrounding issues.  FSP is supposed to be a comprehensive wrap-around approach.

HCA History - Psychosis Efforts

Research Psychosis – Work Done

Of course psychosis is a serious concern that needs to be addressed.  Now our existing services appear to be performing poorly.  We measure performance as a reduction in new cases as well as substantial remediation of existing cases.  In our community a significant number of those diagnosed with psychotic features are just timing out.  In other words they are dying before any help arrives.  Although our Housing Solutions Bundle (HSB) is not directly designed to mitigate psychosis associated issues it will have a considerable impact on the Quality of Life (QOL) of those impacted by psychosis. 

[PICTURE OF A PSYCHOTIC PERSON DYING]

Figure – The BadBed

[ROCHESTER GALLERY & & LINK TO WOUNDED WARRIOR]

Wounded Warrior – BASALT – Presented by Keith Edward Torkelson, M.Sci. With MSG

https://ktork46.blogspot.com/2017/03/wounded-warrior-basalt-presented-by.html

Publication Stats for Wounded

When we discuss housing issues we get fewer readers that let’s say a report on PEACE.  To have 191 readers with housing and unmet needs is a good achievement.

OCHCA Psychosis Summary

“ochca psychosis support”

Peculiars about the new INN Project, Improving the Early Identification of Youth at Clinical High Risk for Psychosis and Increasing Access to Care (CHR).  In short, First Onset and Early Learning should cover the bases as discussed with Clinical High Risk (CHR).  As we see it any new effort that is not substantially different will supplant the existing services.  Our housing approach is a less clinical approach to tame ancillary issues such as psychosis.  Our Housing Solutions Bundle (HSB) will globally impact the lives of those dealing with Behavioral Health issue including Substance Use Disorder (SUD).

MSGBase > Metadata

Evidence of Shady Ideas

Now we return to submitting MHSA Innovations Project Ideas (IPIs).  First and foremost the HCA website that says INN project submission is on “Hold” while concurrently new projects are being presented.  The MHSOAC most likely has in its’ records the request from Orange County associated with HCA’s COVID response to migrate MHSA INN funds into other accounts such as CSS to balance the books.  Reports indicate that the MHSOAC responded saying such an action could not be done.  Now more than ever before the OCHCA is increasing secrecy.  Consumers and other stakeholders say the HCA is failing its’ role with MHSA mandated communications.

Ethical Issues – Transparency & Accountability

One of the MHSA Principles is transparency.  Immediately the County should be encouraged to share at a Behavioral Health Advisory Board (BHAB) the: Who, what, when, how we stakeholders can get back on track with respect to OCHCA MHSA Innovations.  If an interested party Googles “OCHCA MHSA Innovations” they should hit the page telling any and all stakeholders what to do.  In terms of accountability the HCA needs to generate and share cost-benefit studies.  Once again one of the psychosis projects listed above could pave the way.

Staffing Issues

In the day, 2010, the OCHCA (HCA) provided the public with both the HCA and MHSA Hierarchies.  Included in said hierarchies was include administrative vacancies.  At the BHAB meetings the emerging BHAB members have asked for the current hierarchies including contact information.  From what we can tell the HCA is facing significant staffing issues.  For example the HCA director Clayton Chau MD has doubled and may still double as Chief Medical Officer.  Try as we may we cannot figure out for any degree of certainty who heads up MHSA Coordination.

Catch Up – The Last Network

The last lead we had on MHSA Coordination leads us to Sharon Ishikawa yet she did not respond.  We have an outstanding email to Annette Mugrditchian, Director of Operations: Orange County Health Care Agency: Behavioral Health Services yet she has failed to respond.  The HCA indicates this failure to communicate is due to a shortage of staff and too much work.  We always thought the Annette was in line after Dr. Jeffery A Nagel to take over as the HCA deputy director in charge of Behavioral Health Services.  Someone in the county, potentially Dr. Chau, selected Dr. Veronica Kelley as BHS Director.  Dr. Kelley so far does not appear as literate as Annette.  When it comes to the full picture spanning more than ten years it looks like Dr. Kelley has about nine more months to catch up.  If now by then then the unfolding on new will dominate her time spent and her MHSA History learning curve we flatten.  One thing she can do is cancel existing programs and start over.

Work on Regulations

Years ago Buster helped the MHSOAC with drafting their MHSA Innovation’s regulation.  He just wanted to get his word in when it came to MHSA Innovation (INN).  One he tried to push that INN project should have a 3 year time limit.  He suggested that Innovation projects might be timewise aligned better.  In addition, no INN Project should cost more the $1,000,000.00 per year.  Now we believe that $2,000.000.00 is OK.  In keeping we feel the five or so million for the proposed psychosis management project is way over the top.

Recommendation

[We recommend against approving the new OCHCA Psychosis CHR project]

Not leveraging existing infrastructure

Instead of building the CHR system from scratch they could piggyback it on an existing program.  Give money to the existing FSP to develop the tools they specify.

Strategically of the Mark

Back before COVID (2019) the county wide consensus was that we need to resolve Housing Concerns including getting our homeless into GoodBeds.  We know resolving psychosis is fundamental to Health and Human Services.  Yet, given the current efforts have not substantially remedied psychosis we need to re-tool existing programs.  Since 2020 Housing has been left out to dry.  We monitor the OCHCA What’s Up Newsletter to see what Director Chau is busy with.  He has not been busying himself with Housing.  The psychosis money would better be spend back with Housing.

New Administrator Asks for No Complaining

In December of 2021 the OCHCA appointed a new deputy director.  This marked the retirement of our friend Dr. Jeffery A Nagel.  During January and February 2022 the new deputy director of Behavioral Health Services (BHS) took the time to orient her one of her communities (BHAB) about how is and she will do things.  It reminds Buster of when doctors say: “This is how I choose to run my practice”.  The new and improved BHS Director specified that she would not entertain any complaints.  The MHSA was actually founded off of complaints.  Complaining is the MHSA way.  This paper is one way that we here at Mentalation Solutions Group (MSG) will process our concerns so Buster can complain less.  In this incidence we escalate up to our friends at the MHSOAC.  Rather than saying we have some complaints, we will just say the material presented here are serious concerns.

Underservice and Inappropriate Service

On any given day Buster observes up to twenty persons out in our community that are under-served or receiving inappropriate services.  This concept is out of scope for our study here yet we include a link to one of publications.

[INCLUDE LINK TO HOMELESS] 

Friday, October 30, 2020 [Exhaustive Homeless Gallery]

“We Walk quietly among our Homeless” Homeless Gallery - Orange County Centered by Keith “Buster” Torkelson and MSG (202010)

https://housingadvisoryboard.blogspot.com/2020/10/we-walk-quietly-among-our-homeless.html

New Deputy Director – Selective Hold

In December of 2021 the OCHCA appointed a new Deputy Director.  The new director’s specialty is Behavioral Health Service.  We really probably would not mention them except this year (2022) at a BHAB meeting they gave an Innovations Projects update.  The projects presented appear to be new projects.  How can we get to new projects with the “Hold” in place?

MSGBase > Metadata >

MHRS Chief’s Report – Dr. Veronica Kelley

Whereas prior administrators at her level called the position Director of Behavioral Health Services (BHS) Dr. Kelley is going with Chief, Mental Health and Recovery Services (MHRS).  In her report, Dr. Kelley noted that Orange County submitted two No Place Like Home (NPLH) applications for MHSA housing projects. She noted that the MHSA Community Engagement Meetings (CEMS) for general community members started in February and will continue through March 3, 2022, and that they conducted meetings on two potential Innovation projects- Clinical High Risk and Early Psychosis and Young Adult Courts.  We have been following NPLH ever since 2018 when Dr. Janel Alberts sold us the idea.  We do not support investing too much in the NPLH solution.  Just other approaches to creating Beds without our Housing Solutions Bundle (HSB) the county will find it hard to put (place) people is a GoodBed.

Feature – Innovations Project Idea (Revisited)

MSGBase > Metadata > CHR

Supplanting

The County of Orange already has programs in place to address psychosis in youth.  An example is the Full Service Partnership OC CREW.  If something as big as the proposed Improving the Early Identification…is now justifiable this indirectly indicates that existing programs such as OC CREW are fallen way short.  Full Service Partnership means just that full and anything it takes. 

FYI - Early Onset Psychosis - Orange County, California

https://www.ochealthinfo.com/services/children-families/mental-health-and-recovery-services/children-youth-services/early-onset

“The Orange County Center for Resiliency, Education and Wellness (OC CREW) program provides early intervention services to Orange…”

CHR - Awarding the Contract

The presenters Schiffman and Nguyen put a good deal of effort into their presentation.  In fact it is one of the more detailed Innovation’s presentations that we have reviewed.  One again we don’t know where they are or think they are in the MHSA INN cycle.  Schiffman (UCI) and Nguyen (MHA) came across as if they had responded to the RFP and were awarded the contract.  As we the majority of those who submit an idea usual do not get the contract.

Too much money

We wonder why they want to push forward an idea costing some odd $5,000,000 per year.  One reason may be that big projects take less effort than do many small efforts.  We feel that it would be nice if we could look at the MHSOAC website and webpages to answer our Innovations related questions.  Questions such as: With all of the HCA MHSA Innovations projects, what are the projects and where is each in the delivery cycle.  In addition are any of the results worthwhile.

Project Sizing – I Don’t Come Easy

No one ever said that administering to the MHSA Innovation Component will be easy.  When we worked on the MHSOAC Innovation’s regulations we pushed for a $1,000,000 cap per project per year.  Since MHSA funding is associated with population size Orange County has a sizable INN funding base.  We propose that any project asking for more than $2,000,000 per year is too big.  In the beginning “The OC” developed small and medium projects.  We consider a round of projects to start when the HCA sends off their INN project idea plans (proposals) to the MHSOAC.  With a relatively recent round of projects plans that “The OC” sent up to the MHSOAC numbering more than five (5) the MHSOAC turned down more than half.

System Transformation

Since the MHSOAC kick in the rear “The OC” has favored planning large projects to save time, effort and heartache.   An example of pushing through a large project is Behavioral Health Services (BHS) System Transformation that spent $9,000,000 fiscal year 2019-2020.  It is hard to believe that System Transformation is an Innovation.  It defies any grassroots philosophy.  System Transformation seems more like General System Development (GSD) to us.

2020 - COVID and Squeezing out Innovations

Soon after the idea shut-down and “Hold” COVID hits!  Financial analysts expected the worst about MHSA monies.  In order to get the over and through COVID the MHSA Budget concerns the county proposed moving Innovations monies away to cover CSS and PEI.  An HCA administrator indicated that the MHSOAC would not permit it.  Then the HCA posits supporting larger than average projects.  Yet remember the “Hold” is still supposed to be in place.  Another idea to balance the books was to take some or all of the Prudent Reserve.  They were squirming yet budget wise this are better again.

SCM V MHSOAC - History of Yeses

Buster has attended OCHCA MHSA Steering Committee Meetings (SCMs) since 2009.  In that time he has not witnessed any proposed program or project voted down by the SCM.  After something passes with the SCM then the Mental Health Board (MHB) had a shot at it.  We do not know the voting distribution for the MHB because Buster did not attend all that may MHB meetings.  Yet, he was surprised to discover that the MHB is associated with the HCA.  We feel the MHB / HCA association is a conflict of interest for the community at large.  Here we encourage the MHSOAC to not approve the OCHCA’s Innovations project addressing earlier that early intervention particularly with youth.

20210419-M: OCHCA MHSA SCM

At the middle lay many things that are MHSA, Sharon Ishikawa advices for the stakeholders to have “Patience”.  She said to plan your MHSA including Innovations (INNs) efforts for future money circa 2023.  Yet before we know it 2023 will be here and we will have yet to get an up-to-date Submission schedule”.  OCHCA MHSA INN materials originally indicated submission had a deadline for each round.  Now it looks like INN submissions are open ended.  At some point there must be deadlines because without them they would find it hard to cutoff the submissions and begin further processing.

From the MHSOAC we request >

[Who-How-When-What]

Housing Solutions Bundle (HSB)

In some ways we have benefited from our problems with OCHCA MHSA Innovations.  We have had the opportunity to critically review some of the younger administrators.  Even though Mentalation Solutions Group’s (MSG’s) Housing Solutions Bundle (HSB) was needed yesterday it we be a better and more fully developed product in the face of the “Hold”.  We also feel that it might be best sold under the Prevention & Early Intervention (PEI) component to CalMHSA.

Last Reviewed: 20220314-M:  All were HCA Deputy Directors Except Dr. Chau is now the HCA Director and Chief Medical Officer and Dr. Kelley is now the incumbent HCA Deputy Director over Behavioral Health Services.

Housing Solutions Bundle Promotion [STAYED]

We will assume we have described Mentalation Solutions Group’s (MSG’s) Housing Solutions Bundle adequately for our purpose here.

MSGBase > Metadata >
14_Address_Board_BHAB_HSB_22030901_Notes

Impact of MHSOAC Saying to the OCHCA!

MHSOAC Says No #3!

Really Shaken Up! – HCA Reaction to Champion Huge Projects

We here at MSG consider any Innovations project with a yearly budget exceeding two million dollars per year a Huge Project. A benefit of picking huge projects is that it reduces the county workload.  No one ever said that properly administering to the MHSA INN Component should be easy.  The OCHCA now reduces time spent for a round of Innovations.  This forgoes true Innovations that could yield a rainbow of solutions.  What if one of the HCA’s Huge Projects fails to deliver?  Not all Innovations projects after close are picked up to sustain by the HCA.

Impact of MHSOAC - Wasted Effort

After an Innovations plan passes the initial vetting stage it takes a good deal of time to prepare an idea as a plan for sales with those that may approve it.  It broke some at the HCA’s hearts when the MHSOAC failed to green light so many proposed plans.  The HCA reacted quite liberally.  For example the OCHCA’s shut down the submission of new ideas.  Another reaction was to select projects that would spend a good deal of money.  If the HCA gets turned down by the MHSOAC for an Innovations project plan this causes a scramble.  Public Health is rather crazy.  One the HCA cannot make a profit.  The HCA must spend the allocated monies in this case Innovations dollars.  If they do not spend money the money could revert.  Remember back in 2010 a substantial amount of MHSA money was stuck in Sacramento.  Stuck up top enough money that moving it away from the MHSA was placed on the ballot as Proposition 1E.  And yes if we were in the HCA’s shoes we would freak out a bit.

Summary

Here we summarize going backwards.  We only select things that will help us with selling our Housing Solutions Bundle (HSB) product-line.  For this report we will try something new.  We will are writing a summary then moving it up front as the Abstract – Executive Summary. Return to the top for the Summary.

Context Assessing MHSA Innovations Component

Published on AnimaCules Blog
OCT 9 (2014)
MHSA Innovations Outcome Measures Manual Round 01 by MSG

https://ktork46.blogspot.com/2014/10/mhsa-innovations-outcome-measures.html

Results for Outcome Measures Manual (MSG, 2014)

Orange County: MHSA: Innovations Round 1 – Tools Used in Projects

Outcome Measures Matrix (Table)

Last Reviewed: 20220407-TH: Results of MSG’s Outcome Measures Study about Instruments Used in Orange County

 

MHSOAC Related List of Contacts https://mhsoac.ca.gov/contact-us/

Address an MHSA-Related Problem?

Do you have an MHSA-related issue to bring to the attention of California’s Department of Health Care Services?

Yes we do have a few issues to bring to the CDHS.  Less that one (1) month ago we tired to go through channels and have the MHSOAC help us out.  The Rep to which we were assigned has been unable to communicate with us in a timely manner.  We were going to call yet we have to stop somewhere in our efforts and print our findings.  For the time being we here at Mentalation Solutions Group (MSG) are not satisfied with the MHSOAC.

Please submit your concern by email to mhsa@dhcs.ca.gov or in writing to:

 Department of Health Care Services

• Mental Health Services Division
• Attention: MHSA Issue Resolution Process
• 1500 Capitol Avenue, MS 2702
• P.O. Box 997413
• Sacramento, CA 95899-7413

Old Contacts MHSA Network 2.0

For Keith “Buster” Torkelson MS we are building our third MHSA Network (Network 3.0).  Buster came on board with the OCHCA back in 2009.  He assumed many roles (refer to Mini-bios up front) including odd jobs.  The HCA persons in place as of 2009 formed Buster MHSA Network 1.0.  As HCA employees moved on, dropped out or retired his Network 1.0 developed many holes.  When Mary Hale MS was apparently fired Buster began forming his MHSA Network 2.0.  As of January 2022 we are creating what we hope with be Buster’s last MHSA network 3.0.  Two of the old-timers in Network 3.0 are Clayton Lon Chau and Andrew Inglis.  This succession business can be challenging.  Just as someone appears to be doing good work they move on.

Current (2022)

https://mhsoac.ca.gov/contact-us/

Program Operations Dr. Sharmil Shah > sharmil.shah@mhsoac.ca,gov

MHSOAC Current Resources

Around 2014 Buster peeked with his work associated with the MHSOAC.  Now we prefer written documentation over phone calls.  If we had obtained written records we would better proof of how much time Buster spent helping the MHSOAC.  We checked online finding these to be the MSOAC go to people.  After this will include some of Buster out of date MHSOAC go to people.  You can see how old our MHSOAC go to list is particular about Matt with a DMH address.  DMH has gone extinct.

 “Please contact MHSOAC staff for any questions regarding the MHSA”

We did and have received nothing that we asked for!  We contacted Nev below because most of our issue center about MHSA Innovations.

MHSOAC - Contact Us

Mental Health Services Oversight and Accountability Commission

http://archive.mhsoac.ca.gov/ContactUs/ContactUs.aspx

Table – 2022 MHSOAC Contacts

Rapport Developed During Work on MHSOAC authored Regulations.  In addition with helped the MHSOAC with some work on Innovation Assessments

Table – MHSOAC Legacy Contacts

FYI

“Correspondence to the MHSOAC as a whole, or to an individual Commissioner, should be addressed to the following address”

Mail: 1300 17th Street, Suite 1000; Sacramento, CA 95811

Email: MHSOAC@mhsoac.ca.gov

Figure – Timeframe for the work Buster did on behalf of the MHSOAC writing Regulations.

MSGBase > Metadata

Query Hits - Order in Google hit list.

We retained the original order for the Google Hits with “OCHCA MHSA Innovations submission process”.  If things were up-to-date what we need to know about the current HCA MHSA Innovation process should come up in living color.  All the hits are out-of-date with respect to current (2022) goings on with HCA MHSA Innovations.  As you can see Google reports us visiting some links more than one time.  The most up-to-date material is date Feb 25, 2022.  We will focus on this a bit more than the other Google hits.

AGENDA - Orange County Health Care Agency

https://www.ochealthinfo.com/sites/hca/files/import/data/files/107972.pdf

Sep 13, 2019

This hit addresses the relatively new MHSA Innovation Idea Generation Website.  It provides resources and information about the MHSA INN process.  It addresses the “Submission Process”.  Before we knew this didn’t apply anymore we found this tool confusing.

You've visited this page 2 times. Last visit: 2/23/22

Orange County Health Care Agency Behavioral Health Services

https://www.ochealthinfo.com/sites/hca/files/import/data/files/80073.pdf

Jun 18, 2018

This hit addresses MHSA Innovation (INN) Projects.  It advises us stakeholder that “viable ideas submitted before June 8 may be posted for use of AB 114 reverted INN funds”.  The document is not time stamped so we have to assume the year is 2018.  The document also indicated the information contained within will help us with the “Submission Process” including offering “Helpful Tips”

You've visited this page 2 times. Last visit: 3/13/22

Innovation | Orange County, California - Health Care Agency

https://www.ochealthinfo.com/page/innovation

This is actually an undated website.  It basically offers an overview of “The MHSA Innovation component”.  This information at one was to gold standard in working up a MHSA INN Project Idea.

It says that the MHSA INN component “The MHSA Innovation component is designed to evaluate the effectiveness of new or changed practices in the field of mental health, with a primary focus on learning rather than filling a need or a gap. Five percent of the MHSA funds are dedicated to the Innovation component. Each project must be approved by the Mental Health Services Oversight and Accountability Commission. Innovation projects are time-limited to a maximum of five years, after which an alternative source of funding must be identified if the project is deemed successful.”

You've visited this page 2 times. Last visit: 1/14/22

Mental Health Services Act

https://www.ochealthinfo.com/sites/hca/files/import/data/files/40122.pdf

Oct 3, 2014

This was about time that the Innovations Advisory Committee on which Buster served was disbanded.  The document addresses HCA INN Round 3 Innovations. The Round 3 format was taught by the county to any interested.  Buster attended the training.  The document discusses the “Idea Submission Process”, the role of the “MHSA Steering Committee” and some “Background Information on MHSA”. The background information addresses the MHSA as “Proposition 63 passed in 2004”.

Orange County Community Planning Proposal 2-25-2022.pdf (2 Pages)

https://www.ochealthinfo.com/sites/hca/files/2022-02/Orange%20County%20%20Community%20Planning%20Proposal%202-25-2022.pdf

Feb 25, 2022

This is the document that we hoped would solve our complaints.  Doctor Chau an acquaintance is in the header.  Even though his total time with the HCA is fairly long he is relatively new to his job a HCA Director.  In addition Veronica Kelley, DSW, LCSW is included in the header.  Dr. Kelley is very new to her job with the HCA.  Since December of 2021 Dr. Kelley has been HCA Deputy Director over Behavioral Health Services.  For some reason she changed the name of the position Behavioral Health Services to Chief of Mental Health & Recovery Services.  It has already been a quarter of working for Dr. Kelley we recommend that she create a how am I doing survey to collect stakeholder impressions at the upcoming (April 15, 2022) Mental Health Association (MHAOC) Meeting of the Minds.  All-in-all this document didn’t have what we are looking for.

MHSA Innovation Project/Budget Proposed Changes – Orange County

https://www.ochealthinfo.com/sites/hca/files/import/data/files/74712.pdf

Dec 1, 2017

Let us just call this the HCA INN Round centered about 2017.  These projects would be considered old projects.  Right up front they shot down three (3) projects. The document concentrates on what they call at the time Mental Health Technology Suite.  Doctor Chau seems to like technology.  Actually MHTS might better be funded under MHSA Technological Needs.  The document does offer a bit of an INN primer and the role of the MHSOAC.