Humboldt behavioral health staff outlines adult system of care, flags funding limits for REST innovation program

Jack Brazo, a Humboldt County behavioral health staff member, presented an overview of the county’s adult system of care to the Humboldt County Behavioral Health Board on the board’s regular meeting, describing how clients move from same-day crisis care into outpatient services, supported housing supports and specialized programs for older adults and people with severe, persistent mental illness.

Brazo told board members the system begins with same-day services and the county ACCESS assessment, where “we determine the eligibility for services” and perform Medi-Cal-required assessments to establish medical necessity. He summarized how clients can then be referred to outpatient therapy, case management and psychiatry, and to specialized programs such as REST (Resident Engagement and Support Team), the peer-run HOPE Center and the CCT full-service partnership model.

The presentation used a vignette (“Sam”) to illustrate typical pathways: a same-day crisis assessment at the county campus, an ACCESS assessment and a diagnosis that qualifies the client for county services, referral to outpatient therapy and case management, placement in supported housing, and continued wraparound support from REST or CCT as needed. Brazo said REST “is really part of our innovation funding that we got a few years back, and it follows a lot of housing-first principles.”

Why it matters: Board members pressed on funding sources and program capacity while staff outlined services for several groups — transition-age youth, people exiting crises, and adults 60 and older with comorbid medical needs. The county’s ability to maintain some programs depends on time-limited innovation grants and the shifting state funding landscape, officials said.

Key program descriptions and details provided by staff: - Same-day services: Crisis risk assessments, 51.50 evaluations where indicated, brief therapy and case management; location noted as the county campus at 720 Wood Street. - ACCESS: The adult assessment used to determine Medi-Cal medical necessity, establish diagnoses (example given: bipolar disorder) and schedule psychiatry follow-up. - Adult outpatient: Individual therapy, group therapy, case management and individualized rehab delivered by paraprofessionals/case managers focused on symptom-specific skills work. - REST (Resident Engagement and Support Team): Focuses on supporting recently housed people with tasks of daily living and housing stability; REST works closely with supported housing sites (named examples in the presentation: Bayview and Pine Hill). - HOPE Center: A peer-run center at the county campus offering recovery education classes, community-building activities and peer support; staff and volunteers identify as having lived experience. - CCT / Full Service Partnership (FSP): Intensive team-based supports (clinician, case manager, nurse, peer) for people with severe and persistent mental illness intended to reduce hospitalizations, jail time and placement episodes. - Regional services: County outpatient-style services offered in outlying communities (presentation listed Willow Creek and other local sites) with substance-use disorder (SUD) collaboration in those areas. - Older-adult program: Intensive case management and in-person psychiatry for people age 60 and older with co-occurring physical health concerns; staff stated the program’s caseload is “probably around 50 or so clients.”

Funding and capacity concerns: Brazo and other staff said REST began under a limited innovation grant (five-year term) and that county staff are already discussing how REST activities could be braided into Behavioral Health Services Act (BHSA) funding or CalAIM supports once the innovation funding sunsets. Brazo said he expected the REST innovation funding window to be ending “within a year or so,” and county staff at the meeting noted CalAIM and BHSA are already funding overlapping services.

Board questions and follow-up: Board members asked about eligibility rules for older-adult services, program capacity, coordination with inpatient and community partners, and whether REST could continue after innovation funding ends. Staff said older-adult eligibility is not income-based but targeted at people age 60+ with mental illness and comorbid physical health concerns who are at risk of losing housing or needing Adult Protective Services (APS). On capacity, staff described referral review processes and said supervisors evaluate new referrals against caseload limits.

A formal housekeeping vote earlier in the meeting approved the previous meeting’s minutes; the board recorded that the motion passed with an affirmative voice vote.

Ending: Staff said they will continue to pursue braided funding strategies and to coordinate with regional partners and state programs (CalAIM, BHSA) to sustain REST and related housing supports. Board members asked staff to return with any policy or budget implications for future agendas.