Presented by Telecare's President and CEO, Anne Bakar for Senator David Pan's (D-SAC) global mental health forum on February 28, 2018.

1. System Innovations in California:
The Impact of the Mental Health Services Act (FSP) Programs,
Pay for Success, and Expanded Crisis Care for People with
Serious Mental Illness and Other Challenges
Anne L. Bakar
President & CEO
Telecare Corporation
February 28, 2018

2. Statewide Leadership Matters
• Thank you Senator Dr. Pan, Mayor Darrell Steinberg,
and Maggie Merritt from the Steinberg Institute for organizing
this international briefing.
• It is my honor to highlight the significant innovations in behavioral
health that have been taken to scale in California over the past
few decades.
• The state legislature has played a vital role in these
systems transformations, and is critically needed to advance
additional progress in the years ahead.
• We appreciate your time and attention to this growing statewide need.
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3. Telecare Corporation
• Telecare has over 50 years’ history of providing outstanding behavioral
health care services to individuals with complex needs. Provides
inpatient and outpatient services: primarily in partnership with public
entities, (25 California counties), and insurance plans.
• 3,500 employees in 7 states, family- and employee-owned.
• President & CEO Anne Bakar has led Telecare for more than 30 years,
through turbulent health cycles.
• She has been formally commended by United States Senator Dianne
Feinstein, and Congresswoman Barbara Lee, as well as former State
Senate Pro Tempore Darrell Steinberg, and former State Senate
President Pro Tempore Don Perata. She is a national board member at
the Kennedy Satcher Center for Mental Health Equity, and an active
member of the National Council of Behavioral Health, as well as several
other state and national entities.
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4. Observations of System Successes and Innovations
• Mental Health Services Act (MHSA) and Full Service Partnership (FSP) Programs:
Funded by the MHSA and tied to specific outcomes, FSPs have dramatically contributed
to reductions in hospitalizations, incarcerations and homelessness statewide.
• Has been a transformative approach for clients and county systems for those with serious mental
illness. Where it has been studied, it has dramatically reduced costs statewide for this population.
• “Pay for Success”: Introducing value-based performance measures into the behavioral
health field. Telecare and Santa Clara County are operating the first national “pay for
success” behavioral health care program, with positive initial results.
• SB82 Investment in Mental Health Wellness has provided funding to buttress the crisis
safety net through a variety of program models including mobile crisis, residential care,
and diversion.
• These programs have been very successful reducing the need for emergency hospital care and
discharging individuals back to their community setting.
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5. The MHSA and Full Service Partnerships (FSPs)
5
Proposition 63, also known as the Mental Health Services Act
(MHSA), was approved by the voters in November 2004.
• Has added over $1-2 billion annually to the public mental health
budget.
• Was launched as a catalyst for systemwide transformation in
the public mental health system, and has been most essential
in securing the safety net; especially in economic downturns
like 2007.
• A significant portion of annual funding is dedicated to an
innovative program model: Full Service Partnerships (FSPs).

6. Full Service Partnerships (FSPs)
6
• Based on SAMHSA’s evidence-based practice of Assertive Community Treatment.
• Adapted for California, and taken to scale because of the MHSA:
o Programs are team-based, integrating multiple disciplines of psychiatry, nursing, social work,
peer support specialists, personal service coordinators and substance use counselors
o Support is available 24/7 and services are client-centered and flexible
o Care is provided “in-vivo” where the client is at with “whatever it takes”
o More active role of consumers including peer staff roles
• Focus is on engaging individuals who would otherwise be homeless, incarcerated, or in the
hospital.
• The results that are studied are very impressive in terms of clinical, social and financial
outcomes.

7. 7
Los Angeles County
FSP Adult Results
Outcomes: 12,897 Clients served
(Telecare & non-Telecare Programs)
• 25% reduction in clients hospitalized
• 47% increase in clients living
independently
• 17% reduction in clients in jail
• 30% reduction in clients homeless
Number of Clients Included: 12,807, FY16-17
Number of Baselines Included: 13,481
Source: “Mental Health Services Act (MHSA) Annual Update Fiscal Year 2018-2018”
Debbie Innes-Gomberg, Ph.D. January 17, 2018
5,133
3,170
2,422
5,354
3,852
4,652
2,008
3,723
0
1,000
2,000
3,000
4,000
5,000
6,000
Hospitalization Independent Living Jail Homeless
Clients
# of Clients Pre # of Clients Post

8. 547,787
801,365
287,276
1,318,217
182,383
1,172,214
105,001
409,398
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
Hospitalization Independent Living Jail Homeless
Days
# of Clients Pre # of Clients Post
8
Los Angeles County
FSP Adult Results
Outcomes: 12,897 Clients served
(Telecare & non-Telecare Programs)
• 67% reduction in days hospitalized
• 46% increase in days living
independently
• 63% reduction in days in jail
• 69% reduction in days homeless
Number of Clients Included: 12,807, FY16-17
Number of Baselines Included: 13,481
Source: “Mental Health Services Act (MHSA) Annual Update Fiscal Year 2018-2018”
Debbie Innes-Gomberg, Ph.D. January 17, 2018

9. Telecare’s Array of FSP Programs
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• During FY16-17, we served 10,848 individuals in our 39 California FSP
programs.
• Telecare has had success adapting the model with a range of populations,
in partnership with our county customers, per local need.
• These include:
o 10 specialized for justice-involved clients
o 5 “Assisted Outpatient Treatment” or AOT, court-ordered
o 1 focused on Transition Aged Youth (TAY)
o 2 older-adult focused, including partnerships with medical (FQHC) and
other providers

10. 10Data extracted March 2016.
STRIDES :
A Longitudinal Study
Our Alameda County FSP program serving
individualswho have spent substantialtime
in lockedmental health inpatient settings
• Experiences of 30 individuals who had been
served by the program for at least 6 years.
This represents individuals with less than a
full year in an IMD the year before
admission, and admitted to STRIDES since
Jan. 1, 2000. By year five, individuals had no
days in a locked subacute setting, despite
having spent an average of 121 days before
entry into the program.
• Days in a locked acute setting also declined
dramatically; in year five and six individuals
had no acute days.
Alameda STRIDES: 6 Yr. Outcomes
Admitted Jan. 2000 – Mar. 2010
36
13
25
6
13
10
4
121
4
15
5 6
0 0
0
20
40
60
80
100
120
140
Before Year One Year Two Year Three Year Four Year Five Year Six
NumberofDays
Acute days IMD/Subacute days

11. 11
CHANGES
Our Alameda County FSP program serving
individualswith co-occurring substance use
and mentalhealthdisorders
• The graph shows the experiences of 61
individuals who were served in the
program in FY16-17 and had been there
for at least a year.
• This compares the year before entry to
the first year in the program, whenever it
occurred.
• There were reductions in acute
hospitalization days, and subacute days
and times. There was a slight reduction in
the number of days in an acute unit.
CHANGES: % Reductions After One Year
24%
2%
13%
71%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Acute Admissions:
Reduction in Number
Acute Days: Reduction
in Number
Subacute Admissions:
Reduction in Number
Subacute Days:
Reduction in Number

12. 12
Partners in
Wellness:
Santa Clara
County &
Telecare
Innovation: First “Pay for Success”
mental health program in the country
• An innovative six-year, performance-based contract to deliver
publicly-funded services.
• Provider (Telecare) at risk to deliver savings by reducing
clients’ use of Psychiatric Hospital, Psychiatric Emergency
Services, State Hospital, and other mental health services
while also ensuring clients’ wellness.
• Objectively evaluated by Dr. Keith Humphreys, Stanford
University.
• Performance targets set to fully pay for program and return
additional savings at the end of the six years.

13. 13
Partners in
Wellness –
Santa Clara
County & Telecare
Cost Savings
In the first year of
operation, the program
saved $508,482 over
the target
Partners in Wellness: January – December 2017
% Reductions in Usage Over Target - Year One Results
25%
35%
81%
100%
22%
0%
20%
40%
60%
80%
100%
120%
Acute Days Subacute Days Psychiatric
Emergency Services
Visits
State Hospital Days Crisis Residential
Days

14. 14
SB82
Investment in Mental Health Wellness
• Passed in 2013, sponsored by former Senate Pro Tem Darrell
Steinberg.
• Provided both capital and operating state funds to create
comprehensive systems of crisis services using proven program
models.
• Counties did innovative customized planning and design to
address safety net gaps.
• Two program models that have seen success:
Crisis Residential & Crisis Stabilization

15. 15
Other Innovative Programs:
Crisis Residential Program: Riverside County
Crisis residential programs provide a safe, short
term (less than 30 days) treatment program –
an alternative to hospitals/emergency rooms.
• Lagos Crisis Residential Treatment
Riverside, CA
• Innovative program design includes lodge-like
great room and a garden, as well as half peer staffing.
• Telecare has to date discharged 94% of clients to lower
levels of care such as home.

16. 16
Other Innovative Programs:
Crisis Stabilization Unit: Riverside County
Crisis stabilization units can divert individuals from the
hospital:
• Multi-disciplinary staff, very short stay (<24 hours)
• Assess, treat and stabilize danger to self/others or
gravely disabled
(5150 criteria)
• Mental Health Urgent Care
Perris, CA
• Riverside County design includes half peer staffing.
• Telecare has effectively served and diverted 99% from
involuntary treatment or hospitalization.

17. Summary Conclusions Reviewed:
• Full Service Partnership (FSP) Programs
• Funded by the MHSA and tied to specific outcomes, FSPs have dramatically contributed to
reductions in hospitalizations, incarcerations and homelessness statewide.
• Has demonstrated that state leadership can foster taking a proven treatment model to scale
without any diminishing the positive results of the model.
• Statewide, approximately 30,000 individuals per year have been successfully served by the MHSA.
• “Pay for Success” Introducing value-based performance measures into the behavioral
health field
• Has paid for itself through positive outcomes.
• SB82 Investment in Mental Health Wellness
• Provides funding to fill the gaps in the crisis safety net.
• These programs have been very successful reducing the need for emergency hospital care and
discharging individuals back to their community setting.
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18. Statewide Leadership Matters
• How can we learn from our mental health successes :
• System approaches
• Effective program models taken to scale
• We need the same commitment and approach with substance use
treatment.
• By supporting both equally, California residents can receive the
behavioral health services they need.
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Any follow up questions, please contact:
abakar@telecarecorp.com
or
frichie@telecarecorp.com