Report 2017-117 Recommendation 8 Responses

Report 2017-117: Mental Health Services Act: The State Could Better Ensure the Effective Use of Mental Health Services Act Funding (Release Date: February 2018)

Recommendation #8 To: Mental Health Services Oversight and Accountability Commission

To ensure that local mental health agencies are able to spend Innovation program funds in a timely manner, the Oversight Commission should continue its efforts to help local mental health agencies understand the types of Innovation projects that the commissioners believe are appropriate. These efforts should include engagement and dialogue with local mental health agencies through Innovation events and forums about the types of innovative approaches that would meet the requirements of the MHSA. The Oversight Commission should use meetings of the Innovation subcommittee or a similar mechanism to evaluate the progress of its efforts to reduce unspent Innovation funds and the need for continued engagement and dialogue with local mental health agencies.

Annual Follow-Up Agency Response From October 2019

The Commission has substantially improved and extended its efforts to develop a shared, statewide understanding of the goals of the MHSA Innovation component and to support local mental health agencies' ability to contribute to statewide learning. During FY 2018-19, the Commission approved over $303 million in county Innovation projects, with an average size of $5.7 million, up from $149 million cumulative and an average size of $4.8 million in FY 2017-18.

Commission staff continue to provide counties with focused technical assistance, centered on the Innovation Toolkit implemented by the Commission in April 2018. Additionally, Commission staff have regularized solicitation of public comments on proposed Innovation project to support local and Commission decision making.

Finally, the Commission's strategic efforts have resulted in the development of several, major, multi-county collaborative Innovation projects and are expected to continue to yield collaborative projects throughout the balance of 2019-20. The Commission provided technical assistance that resulted in October 2017 approval of a major, multi-county Innovation project designed to test the viability of various smartphone applications for supporting effective mental health screening and treatment. The Commission provided a small grant that resulted in December 2018 approval of a major, multi-county early psychosis learning community Innovation project. The Commission in 2018-19 implemented $2.5 million in Innovation Incubator contracts designed to result in three major, multi-county collaborative projects intended to reduce criminal justice involvement of persons living with mental illness. And the Commission is in the planning phases to commit an additional $2.5 million by June 2020 to support further, strategic, statewide investments in Innovative projects intended to reduce criminal justice involvement.

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

1-Year Agency Response

The Commission has continued its efforts to support local mental health agencies, as well as mental health stakeholders to have a shared understanding of the goals of the MHSA Innovation component. More and more local mental health agencies are using the Innovation Toolkit implemented by the Commission in April 2018, which includes information and guidance to support counties in effective design of Innovation projects and a recommended template to assist counties to meet Innovation regulatory requirements.

Commission staff communicate regularly with county staff as counties prepare Innovative Project concept papers and Workplans. Staff highlight the value of completing the Project Plan Recommended Template for designing and presenting Workplans both locally and to the Commission. Additionally, Commission staff have improved communication with stakeholders about public notice and comment periods on draft Innovation Project Workplans to encourage more robust public participation at the county level.

Finally, the 2018-19 enacted budget includes $2.5 million in state administrative funding, with another $2.5 million expected in 2019-20, to support the implementation of an Innovation Incubator as a strategy to support Innovation plan development. The Commission contracted to support the design of a business plan for the Incubator. This design process, which included a series of "design laboratory" events and listening sessions around the state in May, June and July 2018, culminated in the presentation to the Commission of implementation options at the January 2019 Commission meeting. Commissioners directed staff to implement a "hybrid" model for the Innovation Incubator, including internally-managed functions and externally contracted functions. The Commission currently is drafting a procurement to identify an external contractor to manage the external functions, with implementation expected to begin early in July 2019.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

The Commission has continued its efforts to support counties, as well as mental health stakeholders to have a shared understanding of the goals of the MHSA Innovation component. More counties are using the Innovation Toolkit implemented by the Commission in April 2018, which includes information and guidance to support counties in effective design of Innovation projects and a recommended template to assist counties to meet Innovation regulatory requirements.

Commission staff communicate regularly with county staff as they prepare Innovative Project concepts. Staff highlight the value of completing the Project Plan Recommended Template for designing and presenting the plans. Commission staff also have improved communication with stakeholders about public notice and comment periods on draft Innovation Projects to encourage more robust public participation at the county level.

Finally, the 2018-19 enacted budget includes $2.5 million in state administrative funding, with another $2.5 million expected in 2019-20, to support the implementation of an Innovation Incubator as a strategy to support innovation plan development. The Commission contracted to support the design of a business plan for the Incubator. This design process included five day-long "design laboratory" engagements in Oakland (May 8, 2018 and June 4, 2018), Los Angeles (May 21, 2018 and June 11, 2018) and Sacramento (July 10, 2018), as well as listening sessions with stakeholders held in Sacramento on May 4, 2018 and June 20, 2018, respectively, to insure that the business plan presented to the Commission would strongly reflect the principles of the MHSA and would lead to the creation of an Incubator that would be sustainable over time and provide on-going support to counties for mental health innovation. This business plan will be presented to the Commission in late Fall 2018, with implementation expected to begin early in calendar year 2019.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

The Commission has continued its efforts to support local mental health agencies, as well as mental health stakeholders to have a shared understanding of the goals of the MHSA Innovation component. In April 2018 the Commission implemented an Innovation Toolkit for local mental health agencies. The Toolkit was developed with considerable input from county staff and stakeholders. It includes four tools: (1) Innovation Framework Decision Tree that provides information and guidance on how to design Innovation projects; (2) MHSOAC Innovation Review Process that explains the Commission's workflow for reviewing Innovation projects; (3) Innovation Project Plan Recommended Template to assist counties to meet Innovation regulatory requirements; and (4) Presentation Guidelines that provides guidance on how to present Innovation projects to the Commission. The Commission also has continued its engagement with local mental health agencies through presentations at the County Behavioral Health MHSA Boot Camp held on April 16 and 17, 2018, and a meeting of the California Association of Local Behavioral Health Boards/Commissions on April 20, 2018.

Commission staff communicate regularly with county staff as counties prepare Innovative Project concept papers and Workplans. Staff highlight the value of completing the Project Plan Recommended Template for designing and presenting Workplans both locally and to the Commission. Additionally, Commission staff have improved communication with stakeholders about public notice and comment periods on draft Innovation Project Workplans to encourage more robust public participation at the county level.

Finally, the Governor's Budget includes $5 million in state administrative funding to support the development of an Innovation Incubator as a strategy to support innovation plan development. We are working with the administration and the Legislature to secure these funds and provide on-going support to counties for mental health innovation.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2017-117

Agency responses received are posted verbatim.