Report 2012-122 Recommendation 23 Responses

Report 2012-122: Mental Health Services Act: The State's Oversight Has Provided Little Assurance of the Act's Effectiveness, and Some Counties Can Improve Measurement of Their Program Performance (Release Date: August 2013)

Recommendation #23 To: San Bernardino Department of Behavioral Health Administration, County of

San Bernardino County should review its existing MHSA contracts and by December 31, 2013, or as soon as is feasible, amend them as necessary to include plan goals.

1-Year Agency Response

The County of San Bernardino Department of Behavioral Health (DBH) has implemented the recommendation. The DBH has incorporated goals, process measures, and/or outcomes into FY 14-15 Mental Health Services Act (MHSA) contracts processed after the February 2014 Training referenced in the six-month response. Scope of Work goals and objectives correspond to the components of the County's MHSA Plan (County Plan) and are designed to meet the intended program outcomes. This business process has been implemented and will continue for all MHSA contracts.

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

6-Month Agency Response

In September 2013, the County of San Bernardino Department of Behavioral Health (DBH) established a System-wide Evaluation and Outcomes Committee, with the objective to develop a system-wide framework for program goals and outcomes. Membership includes a variety of DBH and community-based organizations. The Committee has developed a matrix of goals and associated key outcomes. The goals are derived from Mental Health Services Act (MHSA) legislation, regulations, and Department of Health Care Services (DHCS) Information Notices; and key outcomes are operationalized ways of measuring progress toward the goals at regular intervals.

Based on Committee recommendations, DBH has provided training on how goals and outcomes are to be integrated into all new and renewed contracts for upcoming contract periods. To expedite effective integration of the new goal and outcomes language into contracts, the Committee has decided to update contracts, as necessary, with this new language as soon as is feasible.

In addition to these internal efforts, San Bernardino County has collaborated with the three counties involved in the State Audit to discuss the best ways to approach goals and outcomes. As a collaborative team, the four counties have developed an additional framework very similar to our internal model that provides what all agree are necessary long-term elements for strong goals and outcomes. With steady progress, this framework provides an effective approach for establishing goals and guiding outcome efforts.

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

60-Day Agency Response

San Bernadrino County, Department of Behavioral Health is currently reviewing plan goals in Mental Health Services Act (MHSA) funded contracts in collaboration with the three other counties audited, Los Angeles, Sacramento, and Santa Clara. The four counties participated in teleconferences on September 30, and October 8, 2013 in which technical assistance was provided regarding MHSA program goal development. Since the release of the audit report, San Bernardino County has been reviewing our existing MHSA plans and related contract language to ensure alignment of program goal statements with MHSA contract language. Continued review will occur during the Fiscal Year 2013/2014 MHSA Integrated Plan planning process, with any necessary contract or plan changes being implemented in Fiscal Year 2014/2015.

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

All Recommendations in 2012-122

Agency responses received are posted verbatim.