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Updating the Community Programming Planning (CPP) processes

Last updated on May 16, 2023

May 5, 2023

A letter to Dr. Bergmann, Director, San Diego County, Behavioral Health Services (BHS).

I hope this letter finds you well. Thank you for giving me the opportunity to speak with you after the Behavioral Health Advisory Board (BHAB) meeting last week. Although I no doubt have irritated you and others due to an apparent lack of tact and diplomacy skills, I hope you have seen me over time as a dedicated advocate for improving our county’s behavioral health system. I have missed so many opportunities to advocate however because I have been relatively stuck on persistently striving to address two concerns, that being the Community Program Planning (CPP) processes and the accumulation of Unspent Funds (UFs).

As we discussed, I am trying to be as able as I can to learn your understanding and beliefs about these issues and I hope you will do the same for me. Although I may be wrong about facets of how these elements are utilized, I do not believe I am wrong about the fundamentals in that we are mandated to give the BHAB an opportunity to ‘review and approve’ a CPP plan and budget, and to address the difference between, what most stakeholders outside of county administration I know who believe, in that we are sitting on an excessive amount of UFs. I know you are beyond busy, but, I too have so many other things to work on and this is seriously hindering my ability to thrive, and not so great for my health.

I heard you too, that my not being clear about nuances of funding factors with BHAB members, who are repeating that messaging without seeming to understand those nuances, is causing confusion. I will do my best in the next week to add a clarifying blog post and ensure that appropriate BHAB and related-committee members are made aware. I believe this could have been avoided had we sat down and collaborated long ago. That being said, focusing on past frustrations is not constructive, so, as for me, I will let bygones be bygones and move forward. My hope is we can collaborate on creating a more inclusive and efficient behavioral health system that values the contributions of all stakeholders.

Although there have been many positive changes in moving in the right direction, I believe that adopting the following CPP-centric elements would illustrate that the BHS and BHAB are taking even bigger steps toward a more inclusive process together. To achieve this goal, I propose planning and moving forward on these elements. I believe we can take baby steps on some of these, and ultimately develop and deploy some or all more completely during the next year:

  1. Develop and deploy a basic CPP plan and budget and get BHAB’s review and approval: By creating a well-defined Community Program Planning (CPP) plan and budget, and getting the BHAB’s approval[i], we can ensure that both the needs of the community are being addressed and that resources are allocated efficiently. This will involve reviewing current processes, identifying areas for improvement, and engaging stakeholders in decision-making. We could start now with a simplified version and document our current CPP using the county’s first-iteration methodology (the Plan, Addendum, & Funding Request), which we could improve upon in subsequent years. From a more structural perspective, there are many elements related to CPP process that need to be identified and used to describe the what, how, and when BHS planning-related elements are generated and disseminated to the BHAB and stakeholders. An extensive statewide MHSOAC CPP analysis was conducted which resulted in these recommendations. One important area to develop, and discussed below, is to ensure BHS has the appropriate level of staff support to help BHAB members and committees meet their responsibilities.
  2. Develop and deploy an expansive training program for BHAB and stakeholders to increase their understanding of the county’s BHS system: The ability for stakeholders, from BHAB members to consumers to advocates, to receive fundamental BHS system training, and for those that are dedicated to being more informed and engaged, training tailored to their individual interests and expertise, will empower all stakeholders to participate more effectively in the CPP planning and development processes of our behavioral health system. Special attention should be focused on training less-engaged communities, especially those that have been traditionally marginalized, and those that do not speak English as their first language. The training Curriculum should include BHS, BHAB, and MHSA fundamentals, specialized topics, and educating stakeholders how to contribute effectively. A process should be developed that guides the BHS and BHAB in how applications will be reviewed and approved on a timely and equitable basis. By increasing stakeholder’s knowledge and skills, we can foster more informed and engaged feedback.
  3. Develop and deploy a process to work with stakeholders and spend down a significant portion of our projected Unspent Fund balance. Initial training should be provided to BHAB and interested stakeholders to understand how these funds are projected, MHSA criteria, why some must be held for future years, and a realistic projection of what amounts are likely spendable. Discussions should then focus on which critical issues could these funds be focused to address and by what means. Once the variety of focuses have been identified, participants would be trained about identified best-practice solutions, inherent challenges, and potential approaches. Then, stakeholders would be trained in how to participate using an innovative decision making tool, a participatory budgeting process. This approach engages stakeholders in the decision-making process, forces them to make difficult value-based decisions about what should receive funding, and allows them to have a more meaningful say in how funds are allocated. This process not only promotes transparency but also empowers the community to take an active role by experiencing shaping the future of our behavioral health system.
  4. Develop and deploy an innovation (INN) project pitch and selection process that includes external stakeholders. The BHS will foster community-driven development of innovative projects through meaningful collaboration between stakeholders in what needs BHS will spend INN funds to address. Stakeholders taking ownership of the process will not only educate them about the issue and potential solutions, but it will also draw them together to focus additional resources on the issue. Developing such a collaborative process would include process training, discussing hot-button community needs, brainstorming ideas, ideally engaging affected communities, narrowing down candidate-projects, and obtaining technical assistance from MHSOAC. Once candidate projects are determined, give the issue-affected community the ability to make the final selection of which project candidates will move forward for BHS proposal development and submission to the MHSOAC approval process.
  5. Develop a CPP-centric website with appropriate functions and features to keep stakeholders informed and engaged: A user-friendly website will provide stakeholders with a centralized location to access information about meetings, events, evaluations, plans, and reports. An extensive array of features was proposed including subscription-based interest lists, a wide range of CPP-related resources from training programs to event and meeting calendars, documents, and materials and other functions and features to keep stakeholders up to date.  By helping stakeholders to stay informed about the issues that matter to them, the BHS, BHAB, and BOS will foster a more knowledgeable and engaged community.
  6. Collaborate with BHAB and the Community Engagement Committee (CEC) to adopt new ideas and processes that improve stakeholder engagement: By working together, we can identify and implement innovative strategies for increasing stakeholder participation in the planning, development, and deployment of our behavioral health system. This collaboration will help ensure that all voices are heard and that our system is responsive to the diverse needs of our community. The CEC will also work to fully engage the BHAB members and deploy a range of improvements that focus the most effective BHAB members on the most pertinent needs of the greater BHAB, BHS, and ultimately provide the BOS with high-value and timely feedback. 

Recommendations 5 and 6 and other ideas are articulated in a Recommendations Proposal to the BHAB Community Engagement Committee. This document illustrates ideas that could be incorporated under the CPP umbrella. It also illustrates the many facets of a stakeholder engagement program and why an agreed upon CPP plan and budget is important.

I am confident that by incorporating these elements into our current system, we can significantly improve our community planning and stakeholder engagement possibilities. This will not only make our county’s behavioral health system more inclusive and efficient but also set a strong example for other counties to follow.

I see your strong vision and capacity for change, I believe your leadership is crucial in making these proposed improvements a reality. Your impressive efforts in reshaping the BHS thus far have laid the groundwork for an innovative, quality, and responsive care delivery system. By collaborating with the BHAB in support of these and related ideas you are effectively growing a group of educated and engaged advocates that will ultimately serve your needs more productively. By including other stakeholders, particularly those with lived experience and those currently receiving services, you are creating a truly effective and comprehensive system with the community rather than for the community. And, by embracing the valuable insights of all of these people, BHS and BHAB can ensure that our behavioral health system remains grounded in the realities of those it serves.

I am committed to working alongside you and other stakeholders to create a behavioral health system that truly serves the needs of our community. I am confident that with your support, we can transform our current system into one that is more inclusive, responsive, and innovative.

Thank you for your time and consideration, and I look forward to any opportunity to meet and discuss these recommendations

Related Resources

Behavioral Health Services

FY2023-2026 MHSA 3-Year Plan and Expenditure Report Draft
San Diego County MHSA Three-Year Program and Expenditures Plan (2005)
MHSA Three-Year Program and Expenditures Plan (2005) ADDENDUM
MHSA Funding Request for Community Program Planning (CPP) (2005)

Mental Health Services Oversight & Accountability Commission (MHSOAC)

MHSA CPP Evaluation and Curriculum Development, Executive Summary
Community Program Planning Processes – Promising CPP Practices
Innovation Framework Decision Tree (Slide 6)
Innovation Incubator Systems Analysis

Other Resources

Best Practices for Inclusive Participatory Budgeting. Urban Institute. August 2022.
BHS Timeline – Proposed Planning and Budgeting Cycle
BHAB Community Engagement Committee | Recommendation Proposal (proposed)

[i] 5604.2(a)(4) Mental Health Services Act (MHSA). (Local Mental Health Board) General Provisions.
“Review and approve the procedures used to ensure citizen and professional involvement at all stages of the planning process. Involvement shall include individuals with lived experience of mental illness and their families, community members, advocacy organizations, and mental health professionals. It shall also include other professionals that interact with individuals living with mental illnesses on a daily basis, such as education, emergency services, employment, health care, housing, law enforcement, local business owners, social services, seniors, transportation, and veterans.”

Updated 5/12/2023 — minor grammatical edits made.

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