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County Spotlight - Nevada

Second Step

This amazing program has helped our Truckee pre-k-8 grade students to problem-solve and know they have the capability and resiliency with which to do so. The students all know the concept of empathy and use it in their day-today interactions and language. The staff sees the children self-regulate and use self-talk in order to calm down. We all hear the kids say things like, “I am going to take deep breaths and talk to you next recess.” The skills for learning are imperative in the new era of “Common Core” and we see the Second Step results of memory, paying attention, listening, and communicating. Additionally, every time a child is sent to the office students are asked to fill out a Second Step problem-solving sheet in order to have a plan for what to do next time if the situation was to occur again. This allows the child to put a plan into place before having to encounter this problem and decide in the heat of the moment. The sheet then goes home with the child and the parent and student sign it after going over it together, therefore enhancing school-home communication, as well as parent-child communication.

We would like to give a shout out to the entire staff of Glenshire Elementary School! They have embraced this program wholeheartedly and are seeing the results and benefits of this program through a decrease in discipline referrals and an increase in kind, empathetic, and respectful students who know how to solve problems. This school put the Second Step Program into the daily schedule so that all teachers have a day and time when the program is taught. They also reinforce the week’s lessons before and after the students go to recess in order for the children to be able to apply the concepts in ‘real world’ situations. The teachers and staff have been trained, as well as the parents. Therefore, the children at this school hear the same language and concepts wherever they go; the playground; the hallway, the office; the special education room, the speech therapist’s room, the ELD teacher’s room, the nurse’s office. Consistency and role-modeling are key to this programs success.

A parent came in to her child’s teacher and said that she was having a tough day and yelling at her child. The child looked at her mom and said, “Mommy, put your hand on your tummy, name your emotion and then take five deep breaths.”One of the third grade teachers took his class to the science fair in our cafeteria. There was much commotion and noise and all of a sudden he noticed one of his students sitting at the end of one of the tables with his eyes closed. The teacher walked over to him and asked if he was ok. The student replied, “That he was deep breathing and using his positive self-talk so he didn’t lose it.”

Our county has amazing statistics to provide through our School-wide Information Systems Data (SWIS). In the last year at the elementary school level, bullying and defiance referrals have gone down 100%. Physical aggression referrals have gone down 30%. Discipline referrals on the playground, cafeteria, and the hallways have all decreased anywhere from 25%-45%. Additionally, these students are very articulate and ask each other to “calm down”, use “heartfelt, sincere apologies”, “show empathy”, “problem-solve”, and use “their thinking brains instead of their feeling brains.”

We are extremely grateful for the ability to have a social-emotional program for our students starting in the early learning years and continuing through eighth grade. After experiencing the trauma and emotional distress of several suicides over the last six years, we hope this prevention model, utilizing Second Step, will increase the resiliency and capability of our youth to work through any situation, no matter how tough! Allowing students to learn the basics of being capable, knowing they can calm down, work through anything, and show and feel empathy are life skills, not just skills for school. We are sure the research five years from now will show a different type of teen entering their high school years, a teen that has options when life puts boulders in their path, options to climb the boulders, work through the boulders, and not ever give up!


Adult Assertive Community Treatment (AACT) &Assisted Outpatient Treatment (AOT)

Turning Point Community Programs Providence Center, Grass Valley
Program Description:

Built upon the strength-based principles of the Adult Assertive Community Treatment (AACT) model, Turning Point Providence Center (TPCP) provides community-based, recovery oriented services on behalf of ninety (90) individuals with severe and persistent psychiatric disabilities with co-occurring substance and/or medical challenges.    Among individuals served are those involved in Mental Health Court (MHC) and those incarcerated or on probation, which may not be enrolled in MHC.  Assisted Outpatient Treatment (AOT) is also provided, serving a subset of individuals meeting a narrow set of criteria for court-ordered treatment.  All services are Medi-Cal and/or Mental Health Services Act (MHSA) funded and designed to increase self-reliance, while preventing or decreasing hospitalization, incarceration, homeless and emergency crisis contacts.
TPCP’s AACT Team operates 24-hours, 365 day per year, providing flexible crisis intervention and wraparound services for individuals 18 years and older.  Individual and group services are individualized and designed for transitional age youth (18-26), adults, older adults and their families in partnership with TPCP staff.  As individuals seek to realize their full potential as people and members of the community, they partner in services and supports with a minimum of two (2) contacts a week with the AACT team. The treatment team includes: personal service coordinators (PSC), psychiatrist, registered nurse, peer supporters, certified alcohol/drug counselor (CADC II), team leaders, court liaison, program director and clinical supervisor.  Individuals served meet medical necessity and reside in both Eastern and Western Nevada County.  
As a California Full Service Partnership (FSP), Turning Point Providence Center emphasizes the core principles of the Mental Health Services ACT (MHSA) and Assertive Community Treatment (ACT).  Clients and their families receive an array of services to promote recovery, resiliency and health. “Whatever It Takes” is part of the philosophy, central to the FSP model and focuses specific needs and strengths of the individual.  The concept includes team input and creativity, offering choices and empowering clients to build on existing strengths in meeting their needs. This is a “no fail” approach with the services continued based on the pace of the client, rather than a pre-determined expectation of progress, timeliness or treatment expectations.        

Outreach and engagement is provided across settings in the community including hospitals, private residences, the local correctional facility, homeless camps and other   community settings to increase the likelihood that individuals will achieve self-defined goals.  This is an essential component in removing barriers, establishing trust and developing the therapeutic relationship necessary for recovery.  Outreach and engagement interventions are provided through a respectful approach that ensures cultural sensitivity in working with individuals, families and across systems.     

Program Goals:
Turning Point Providence Center is committed to assisting persons with psychiatric disabilities in reaching self-defined goals while supporting hope, choice, empowerment, inclusion, wellness and recovery.  These goals embrace the core values of the program which include: client/family driven, teamwork, empowerment, shared decision making, cultural responsiveness, respect, self-determination, privilege to serve and anticipation of individual recovery.
Services and supports seek to reduce hospitalization, homelessness, incarceration or emergency contacts that may lead to higher levels of restrictive treatment.  This is done through outreach and engagement, along with a team approach, increasing capacity for providing the level of care needed to support recovery and overall wellness. 

Overall Structure of AACT Team  
24/7, 365 days per year response
Census of 90
Smaller caseloads (1:10)
Client/Family driven
Team approach

Treatment Includes:
• Assessments- Individuals receiving services through TPCP will participate in a thorough assessment of needs; this will include inquiry and evaluation of cultural or language issues in the formation of diagnosis and treatment.  Staff will work   with clients in developing safe and trusting professional relationships.   
• Psychopharmacologic treatment, including new atypical antipsychotic and antidepressant medications
• Medication Outreach
• Individual and family therapy
• Substance abuse treatment, including specialized groups for individuals with dual diagnosis of substance abuse and psychiatric disability. 
Rehabilitation Includes:
• Behaviorally oriented skill teaching (supportive and cognitive- behavioral therapy, including structuring time and handling activities of daily living
• Support in accessing community groups as Alcoholics Anonymous (AA), Narcotics Anonymous (NA) and co-occurring groups that employ the “harm reduction” model.
• Employment exploration (supported employment)
• Support for resuming or continuing education
• Individual and Group therapy
• Support, education and skill teaching on behalf of family members
• Collaboration with families and assistance to members with children
• Support in acquiring entitlements/benefits
• Direct support to help clients obtain legal and advocacy services, financial support, supported housing, money management services and transportation.

Housing Services:
TPPC’s provides individuals with access to an array of community-based housing options designed to meet the individual needs of each person.  Every effort is made to identify emergency or transitional housing options with a goal of assisting individuals in accessing and retaining permanent housing.  The program offers approximately 10 master leases for homes or apartments in the area, which include accommodations for single or shared housing options.  In addition, TPPC works with Nevada County Housing Authority locations and personnel, assisting individuals with applications for federal subsidies, as available.

TPPC implements support strategies with, and on behalf of, individuals in support of housing success.  These include:
• training in necessary skills to maintain acquired housing;
• timely linkage with utility resources as needed;
• payment of rent and utility obligations;
• repair of individual’s housing when needed;
• assistance with clean-up during and after individuals move out; 
• support with house meetings to promote stability and retention.     

Among community based housing offered is the Catherine Lane Home.  This home provides supported independent living on behalf of six (6) individuals requiring a higher level of support in order to remain safely in the community.  TPPC provides 24 hours staffing to ensure individuals are able to remain in their home and community, avoiding a higher level of restrictive treatment. 

Special Population:
Substance abuse offenders: These individuals are frequently enrolled in Specialty Courts including Mental Health Court, Community Court or Assisted Outpatient Treatment. Some have probation requirements with an extensive history of forensic involvement.  Whatever the situation, AACT services are provided across settings offering an array of services to promote recovery, while reducing the risk of future criminal justice involvement.     
The provider team, including the CADC II and Psychiatrist, works together on the unique challenges of co-occurring recovery, addressing specific needs with the individual and family.  Substance and mental health and medical treatment are provided in an integrated process to address factors including relationships, trauma, medical health, housing and other issues.  Residential treatment may be among the recommendations if appropriate.  Linkage and support to access other community resources is included in rehabilitation options and are prioritized based on the acute needs of the individual.      

Treatment options include evidence based practices such as Moral Reconation Therapy (MRT), Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI).  Other activities recommended include Dragon Slayers (12 step educational group), Alcoholics or Narcotics Anonymous (AA/NA), CADC counseling, individual and/or family therapy to focus on relational/trauma/systems issues and psychiatric medication evaluation for exploring options in treating co-occurring disorders.
Persons with HIV/AIDS:  The AACT provider team coordinates treatment with specialty primary care providers and AIDS drug assistance programs in working to address the complex treatment issues involved with severe mental illness and HIV/AIDS. Integrated health treatment includes, enhanced pharmaceutical support, with frequent psychotropic medication evaluation to determine the need for adjustments due to potential presence of neurocognitive impairment and drug-drug interaction.  As with all individualized plans, individuals with HIV/AIDS are assisted with medication outreach as needed, housing services, as well as participation in all health related appointments and activities assisting in overall health management. 

Registered sex offenders:  Individuals with Severe and Persistent Psychiatric Illness and history of sexual offenses or sexually inappropriate behavior are offered a holistic approach to treatment through AACT services. Treatment is integrated as a co-occurring disorder, similar to Severe Mental Illness and Substance Abuse Treatment.  Treatment is focused on all areas that present problems for successful functioning in the community and includes psychiatric evaluation, medication services, groups and individual therapy.
Barriers to improved functioning and community integration include housing restrictions.  This is addressed by identifying where individuals can be housed without violating registration status and assisting individuals in obtaining and maintaining permanent housing where restrictions do not apply.  As will all special populations, treatment and rehabilitation options are individualized to support these special individuals in achieving quality of life goals by assisting them in symptom management, decreasing levels of stress, while increasing the ability to cope. 

Persons with Untreated Severe Psychiatric Disability:  These subsets of individuals with severe mental illness have a history of lack of participation in mental health treatment that has been a factor in multiple hospitalizations and/or incarcerations or violent behaviors within a specific timeframe.  A significant lack of awareness is a symptom of the SMI which is the main barrier for the individual  participating in treatment.  Enhanced AACT services can engage this special population through outreach, engagement and empowering individuals in making choices that improve the individual’s quality of life.
In some situations, individual are unable to voluntarily participate, due to the severity of symptoms and severe lack of awareness.  When the person’s condition is substantially deteriorating and would benefit from treatment, Assisted Outpatient Services (AOT) is recommended and may be court-ordered.   While AOT provides the same services as AACT voluntary treatment; this requires that a petition be filed and a hearing held to guarantee due process.  If criteria are met, the individual may choose to sign a settlement agreement or be ordered by the court to participate in community based mental health treatment for six (6) months.


SPIRIT Peers for Independence and Recovery

SPIRIT Peer Empowerment Center (SPIRIT) has the Crisis Peer Support program at the Sierra Nevada Memorial Hospital Emergency Department (ED).  Peer Supporters go in and sits with people in crisis waiting for an evaluation from crisis workers. In doing this work SPIRIT has been able to reach people that have not been in the Behavioral Health system before (60% of those seen in the ED for 51/50 evaluation). The Crisis Peer Supporters are well received by the doctors, nurses, and the crisis workers who perform the 51/50 evaluations and we have become a valuable part of the Emergency Department team.
People we have served have benefited in many ways for example; one person was estranged from his family and after building a trusting relationship with the peer supporter he was able to address his challenges and start to build back his family relationships.  That stopped the downward spiral of loss that can happen with mental illness.

Michele Violett Nevada County MHSA coordinator always go above and beyond her job to make sure that MHSA funds are being used in the correct way. Michele has a broad expansive view of the entire Behavioral Health landscape and helps us to see other opportunities that are in our county. She is involved statewide to keep us up on what is going on at the state level.

In fiscal year 14/15 SPIRIT Center was able to help people to find housing and become employable. By meeting people where they were in there journey and building trusting relationships, staff was able to walk with them so they could move forward in a positive direction. By meeting people were they are with acceptance, it helps build their own acceptance to be the problem solvers in their own lives.

Prop 63 brought all the community agencies to the table to design how MHSA was going to be used in Nevada County and with that we became collaborators with one another. We were able to see where the gaps were, once we all came together as a community. Once we saw where the gaps were we were able to come together to address them.


SPIRIT Peers for Independence and Recovery

Hospitality House