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Tarzana Treatment Centers, Inc.

Community Health Needs Assessment

TTC Acute Psychiatric Hospital

Implementation Strategy

I. Identification and Prioritization of Health Needs

Tarzana Treatment Centers, Inc. (TTC) is a private, nonprofit community-based organization that

operates a variety of behavioral healthcare programs and primary medical care clinics. Its 60-bed

inpatient facility is licensed as an acute psychiatric hospital, and therefore falls under the

legislative umbrella of SB697, which mandates that not-for-profit hospitals submit a Community

Benefit Plan. The inpatient facility also meets the requirements of section 501(r), added to the

IRS Code by the Patient Protection and Affordable Care Act (ACA), enacted on March 23, 2010.

Section 501(c)(3) tax-exempt hospitals are required to conduct a Community Health Needs

Assessment at least every three years, pursuant to section 501(r)(3)(a). The objectives of TTC’s

CHNA are to: 1) define the community TTC serves and how the community was determined; 2)

describe the process and methods used to conduct the assessment; 3) describe how input was

gathered from persons who represent the broad interests of the community; 4) provide a

prioritized description of the significant health needs of the community as identified through the

CHNA, along with a description of the process and criteria used in identifying and prioritizing

those significant health needs; and 5) describe the resources available to address the significant

health needs identified through the CHNA.

TTC’s Acute Psychiatric Hospital is located in the city of Tarzana, California, in Los Angeles

County (LAC) in California. LAC is divided into 8 Service Planning Areas (SPAs) based on

geographic region for the purpose of development and coordination of public health and medical

services within the County. TTC’s Acute Psychiatric Hospital is located in SPA 2, which covers

the San Fernando and Santa Clarita Valleys. SPA 2 is identified as the community of focus in

preparing the 2015 CHNA. Clients receiving treatment in TTC’s Inpatient and Residential

Facilities were chosen to represent the target population within the surrounding SPA 2

community.

Patient surveys, key informant questionnaires, and focus groups were utilized to determine

significant health needs in the community. For this iteration of the CHNA, a multi-step process

was used to reach a final list of prioritized health needs, and to inform the development of the

Implementation Plan’s objectives and indicators. First, a consolidated table was created to

summarize the topics/themes that were covered in each primary data source. A check-mark is

used to denote a topic/theme that was covered for that specific data source. Other notes indicate

whether the topic/theme was not addressed in a particular data source, or if a topic/theme was

addressed in another way but not specifically asked through a question, prompt, or discussion.

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The second step was to add more detailed descriptions of the context in which each topic/theme

was covered. This step was essential in order to provide a thorough summary of all topics/themes

covered, and compare and contrast the data to determine similarities between each data source.

Finally, a detailed table was created to show the final list of priority health needs for TTC (see

Attachment). The process involved reviewing each topic/theme according to the data sources,

and including 1) common needs identified between all data sources, and 2) unique needs that

TTC may be able to address. For some of the priority needs, TTC may already be providing

similar services. Needs that TTC will not address were included as needs to be met through

referrals with community partners.

II. Health Needs TTC Plans to Meet:

These are the top six (6) health priorities identified via CHNA process:

Priority 1. TTC will continue to provide the full continuum of SUD treatment services in

the community with an emphasis on providing targeted outreach and engagement

activities to TAY youth, forensic populations, homeless individuals, opioid abuse and the

LGBTQ community.

Priority 2. TTC will continue to provide the full continuum of MH treatment services to

address stigma and serious mental illness (SMI) in the community with an emphasis on

increasing community knowledge and access to underutilized programs for children and

youth such as EPSDT, PEI and mild to moderate mental health services.

Priority 3. TTC’s will assign to the existing CLAS Standards subcommittee the task of

developing a plan to increase TTC’s staff cultural competency via agency adherence to

CLAS standards, implementation of CLAS standards staff training, and the development

of an agency hiring and retention plan to increase TTC’s staff bi-lingual

(English/Spanish) language capability.

Priority 4. TTC will continue to implement its current patient tobacco cessation activities

by monitoring adherence to TTC’s tobacco written policy and procedure and by focusing

on tobacco interventions which reduce TAY youth of tobacco products.

Priority 5. TTC will continue focus on integrating behavioral health and medical care

services by focusing on chronic diseases prevalent in the communities we serve (e.g.

diabetes, obesity, asthma, high blood pressure, etc.) and it’s interaction with SUD/MH.

This includes addressing comorbidity and need to provide integrated and coordinated

care via shared electronic charting and regular provider case communication and

conferencing.

Priority 6. TTC will continue to provide benefits assistance to patients including

education to under insured and undocumented patients who may be able to access

primary medical care and/or behavioral health services via State benefits and/or local

benefits such as MyHealthLA. TTC will seek to expand the number of patients seen in

SUD treatment services under Drug Medical and MyHealthLA.

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III. Impact of Potential Health Care Reforms

It is imperative that TTC protect the health of the communities served through access to health

care. However, TTC’s efforts can be greatly challenged by potential health care reforms under

the new administration. Based on the UCLA Center for Health Policy Research, the following is

at stake:

7.5 million Californians -- almost a quarter of the state's population -- may be uninsured

by 2021 if proposed changes to the nation's health care system are enacted.

23.5 million Americans may lose their insurance, bringing the total of uninsured

Americans to approximately 53.5 million.

Provisions to protect the poor, those with pre-existing conditions, and the self-employed

may be gutted in coming years.

California's economy may be disastrously affected by plans to deport significant portions

of the workforce.

TTC is committed to our agency mission and to the extent possible will seek to implement

strategies that lessen the potential negative impact of changes that may be enacted by new

administration.

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Priorities Objectives Indicators Outcomes (Annual) Continue to provide the full continuum of SUD treatment services in the community with an emphasis on providing targeted outreach and engagement activities to TAY youth, forensic populations, homeless individuals, opioid abuse and LGBTQ community.

Develop targeted outreach activities to increase participation of TAY, homeless individuals and LGBTQ community in available SUD services.

Implement increased outreach efforts to these populations.

Number of TAY SUD clients served.

Number of homeless SUD clients served.

Number of LGBTQ SUD clients served.

A 15% increase of TAY SUD clients from baseline (1,152 in 2016).

A 15% increase of homeless SUD clients from baseline (899 in 2016).

A 5% increase of LGBTQ SUD clients from baseline (321 in 2016).

Continue to provide the full continuum of MH treatment services to address stigma and serious mental illness (SMI) in the community with an emphasis on increasing community knowledge and access to underutilized programs for children and youth such as EPSDT, PEI and mild to moderate services.

Reduce stigma of mental health treatment and SMI in the community.

Increase program utilization for children and youth in EPSDT, PEI, and all populations in mild to moderate MH services.

Increase mental health outreach services in the community

Number of Mental Health First Aiders trained on mental health issues impacting children and youth.

Number of children and youth served in EPSDT program.

Number of children and youth served in PEI program.

Number of all patients accessing mild to moderate mental health services.

At least 200 Mental Health First Aiders will be trained under TTC’s SAMHSA Project FAIR to impact children and youth with mental health problems.

At least 15% increase of child and youth EPSDT clients from baseline (204 in 2016).

At least 100% increase of child and youth PEI clients from baseline of 10 in 2016.

At least 50% increase of all patients served in mild to moderate mental health services from baseline of 81 in 2016).

Assign to the existing CLAS Standards subcommittee the task of developing a plan to increase TTC’s staff cultural competency via on-going CLAS standards adherence, implementation of CLAS staff training and development of a hiring and retention plan to increase TTC’s staff bi-lingual (English/Spanish) language capability.

Develop a plan to implement on-going CLAS standards staff training.

Develop a hiring and retention plan to increase TTC’s staff bi-lingual (English/Spanish) language capability.

CLAS subcommittee annually reviews training and hiring standards.

Percentage of TTC employees who are bilingual English/Spanish.

Number of CLAS trainings held annually.

Number of TTC staff trained in CLAS standards.

At least 45% of all TTC staff will report bilingual English and Spanish capability by end of the year (Baseline is 38%).

TTC’s Training department will provide 2 hours of cultural competence trainings to all administrative staff.

TTC’s Training department will provide 4 hours of cultural competence trainings to all direct patient care staff.

TTC’s CLAS Subcommittee will meet at least quarterly and maintain membership representative of all agency sites.

Continue to implement its current patient tobacco cessation activities with an

Emphasize tobacco cessation services to TAY clients.

Monitor TTC adherence to

Rates of smoking among TAY clients at admission to SUD treatment or primary care.

Reduce TAY smoking at discharge to less than 20% (21% report smoking at admission in 2016).

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emphasis on impacting TAY youth and monitor adherence to TTC’s tobacco written policy and procedure.

smoking policy/procedure through TTC’s annual smoking survey.

Number of patients screened for tobacco use.

Number of patients referred to 1-800 No-BUTTS hotline.

Number of patients willing to quit who received intervention services on tobacco cessation.

Adherence to TTC’s tobacco policy of staff based on the findings of TTC’s staff smoking survey.

100% of patients will be screened for tobacco use.

At least 75% of patients who sue tobacco will have been referred to 1-800 No-BUTTS hotline.

100% of patients that are willing to quit will have received intervention services on tobacco cessation.

100% of staff will have knowledge of TTC smoking policies/procedures and will have read them according to TTC staff smoking survey (Baseline is 89%).

Continue focus on integrating behavioral health and medical care services by focusing on chronic diseases prevalent in the communities we serve (e.g. diabetes, obesity, asthma, high blood pressure, etc.) and it’s interaction with SUD/MH. This includes addressing comorbidity and need to provide integrated and coordinated care via shared electronic charting and regular provider case communication and conferencing.

Focusing on chronic diseases prevalent in the communities we serve (e.g. diabetes, obesity, asthma, high blood pressure, etc.) and it’s interaction with SUD/MH.

Address comorbidity and need to provide integrated and coordinated care via shared electronic charting and regular provider case communication and conferencing.

Provide screening for high HCV and HIV risk behavior and linking eligible patients to HCV, PrEP and PEP treatment when appropriate.

Provide HCV, HIV, PrEP and PEP 101 training for both TTC patients and staff.

Educate the general community on the availability of HCV, HIV, PrEP and PEP services at TTC’s service centers.

Number of HCV, HIV, PrEP/PEP 101 trainings held.

Number of staff trained in HCV, HIV, PrEP, and PEP.

Number of patients who have been screened for HIV and HCV infection.

Number of patients at-risk for HIV and HCV who are tested.

Number of patients provided HIV and HCV treatment.

Number of patients provided PrEP and PEP services.

100% of TTC staff will be required to complete PrEP 101 online training via MyLearningPointe.

Conduct 2 classroom staff trainings related to PrEP at TTC.

At least 750 unduplicated individuals will be informed annually about PrEP/PEP/HIV services.

At least 400 individuals will be referred to TTC’s PrEP Navigators.

At least l 150 unduplicated patients will be linked to PrEP/HIV services.

At least 500 patients will be screened for HIV and/or HCV.

100% of at-risk patients for HIV and HCV will be offered testing services.

80% of patients that tested positive for hepatitis infection will be referred to treatment.

80% of patients that tested positive for HIV will be referred to treatment.

Continue to provide benefits assistance to patients including education to under insured and undocumented patients who may be able to access primary medical care

Provide benefits assistance to under insured and undocumented patients.

Educate under insured and undocumented patients who may be able to access primary medical

Number of patients screened for benefits assistance.

Number of DMC and MyHealthLA patients enrolled in SUD treatment.

100% of TTC patients will be screened for benefits eligibility and be provided enrollment assistance.

Increase by at least 25% the total number DMC patients enrolled in SUD on an annual basis.

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and/or behavioral health services via State benefits and/or local benefits such as MyHealthLA. TTC will seek to expand the number of patients seen in SUD treatment services under DMC and MyHealthLA.

care and/or behavioral health services via State benefits and/or local benefits.

Expand the number of patients seen in SUD treatment services under MyHealthLA and DMC.

Provide SUD treatment services to a minimum of 100 MyHLA patients annually (Baseline is 5.).

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I. Goals, Objectives, Indicators, and Outcomes in Meeting Health Needs:

The implementation strategy described on the previous two pages will be integrated into TTC’s

Strategic Plan, which is updated annually. The table defines the goals, objectives, and indicators

in meeting health needs using a logistic approach. The goal for each health need is translated to

objectives allowing TTC to define the activities that will be implemented. Whether the goal is

being achieved or not will be explained by the indicators or measures for each objective.

II. Specific Resources to Address These Health Needs:

There will be specific resources needed in order to address the health needs listed, and to

continue monitoring progress in the intermittent period before the next Community Health Needs

Assessment. These resources include financial resources, staff, and logistic resources. In short,

financial resources indicate the operating expenses including salaries, wages, and employee

benefits, contracting services, and medical and office supplies, rent and utilities, and information

technology. The facility staff will be trained to help them perform their job responsibilities

effectively, and thus, ensure health needs of patients are met. In addition, the staff will exert

efforts to collaborate with TTC’s partner agencies in referring patients for health needs not

currently being addressed by TTC. The logistic resources will involve TTC management

monitoring and overseeing the utilization of resources to ensure greater impact on the health

needs. Staff in multiple TTC facilities, including the Inpatient Facility, will collect patient data

that will inform the specific indicators determined for each health need. New data collection

required by the implementation plan will be collected by TTC’ in-house evaluation staff. Staff

resources and time will also be involved in participating in and conducting various trainings as

determined by the implementation plan.

III. Health Needs TTC Does Not Intend to Meet:

There were other health needs identified by the survey respondents, key informants and focus

group participants were determined to be out of TTC’s primary scope of services. These needs

include the following topics/themes (see Attachments):

Housing stock in SPA 2 region remains limited and in poor quality.

TTC will continue to work collaboratively with community partners and refer patients to community

partners that provide housing services not provided by TTC such as permanent supportive housing.

Access to food/food security, which significantly impacts the health outcomes for those living in

poverty.

TTC will continue to work collaboratively with community partners and refer patients to available low

cost and free food services, such as food pantries.

Dental health is an often forgotten aspect of health care that can affect many other areas of health.

TTC will continue to refer TTC patients to available dental care services in the community.

Gang violence, unsafe neighborhoods and the involvement of crime and drugs.

TTC will continue to work collaboratively with community agencies that provide gang involvement

services and continue to refer patients to needed services.

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Lack of jobs/job training services, which leads to cyclical involvement in crime/substance abuse and

selling drugs.

TTC will continue to work collaboratively with community partners who provide vocational training

services either on-site at TTC and/or via referral.

Limited and unreliable transportation options.

TTC will continue to provide patient transportation assistance via existing van fleet and ability to leverage

use of bus tokens, bus/metro passes and taxi vouchers in certain service contracts.

IV. Collaboration with Community Partner Agencies:

As discussed earlier, TTC will collaborate with community partners for health needs that will be

addressed as well as those health needs that will not be addressed. TTC currently lacks financial

and staff resources to provide services to address some of the identified health needs. However,

TTC will continue to work collaboratively with community partners to contribute to a healthier

community in SPA 2 and LAC. For example, TTC will continue referring patients to community

partners that 1) provide housing services (not provided by TTC) such as permanent supportive

housing; 2) provide low cost and free food services such as food pantries; 3) provide dental care

services in the community; 4) provide gang involvement services; 5) provide vocational training

services either on-site at TTC and/or via referral. To meet the transportation needs of TTC

patients, TTC will continue to provide patient transportation assistance via existing van fleet and

ability to leverage use of bus tokens, bus/metro passes and taxi vouchers in certain service

contracts. TTC remains an active collaborator in the SPA 2 community and in LAC as well.

TTC will continue to engage with community partner agencies to provide these referrals as

appropriate to help patients meet their other health and health related needs that fall outside the

scope of TTC services. TTC believes that collaboration is an effective way to pool and/or match

existing health-related resources in meeting the health needs in SPA 2.

V. Plan to Monitor the Assessment and Implementation Strategy

Select TTC facility staff in collaboration with TTC’s in-house evaluation staff will develop a

timeline and tracking log to monitor the implementation of the plan. The tracking log will serve

as a tool to determine the progress of the implementation and to determine whether the goals and

objectives are being met as indicated by the indicators and outcomes. The tool will alert the

facility staff to define and implement corrective actions if outcome measures are not being met.

VI. Plan to Document Implementation Strategy

Select TTC facility staff in collaboration with TTC’s evaluation staff will document and prepare

quarterly report to be presented to TTC management and TTC Board. The evaluation staff will

keep and maintain all documents and reports related to CHNA and the Implementation Plan.

VII. Adoption of Implementation Strategy

The Implementation Plan was presented to the TTC Board, which gave final approval in

September 13, 2016. In addition, TTC’s in-house evaluation staff will discuss the timeline of the

Implementation Strategy with TTC’s Board, and present to appropriate TTC staff the tracking

and monitoring tool to assess the progress of the Implementation Strategy.

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VIII. Posting the CHNA on TTC’s Website

As a requirement of the Bureau of Treasury and IRS, the CHNA report and Implementation

Strategy are posted on TTC’s website. Each document is widely available for viewing by the

public. TTC provides clear instructions on how to download the documents with no special

hardware or software required for downloads and TTC does not charge any fees for viewing the

documents.

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ATTACHMENT

Community Health Needs Assessment (CHNA) 2016 – 2018

Summary Table of Needs/Themes Identified

This table summarizes the needs and themes identified via patient survey, key informant interview (KII) and/or focus groups.

Patient Survey (N=125) Key Informants (N=6) Focus Groups

Substance Use Disorder

Mental Health Services

Tobacco Use/Control

Housing

Access to food/food security

Dental health

Gang violence/unsafe neighborhoods

Chronic Disease Prevention & Management

Not discussed

Access to Health Care/inability to get health coverage for undocumented/Health insurance

Not discussed

Homeless services & outreach Not directly asked in survey

Lack of jobs/job training services Not directly asked in survey

Obesity, diabetes, hypertension Not discussed

Transportation

Peer support Not directly asked in survey

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Community Health Needs Assessment (CHNA) 2016 – 2018

Detailed Table of Needs and Themes with Corresponding Recommended Priority for Board Discussion

This table provides additional detail in terms of how the community need or theme was discussed in patient survey, KII and/or focus groups. In addition the last

column identifies the Recommended Priorities that TTC should focus on for the next three year CHNA.

Themes/Topics Patient Survey (N=125)

Key Informants (N=16) Focus Groups Recommended Priority of Focus

Substance Use Disorder treatment remains a

significant need for the SPA 2 population and for

some specific target populations.

(58% agreed) -SUD services for target populations in need: unsheltered/homeless TAY Youth; transgendered individuals).

-Participants expressed gratitude for SUD services that were provided to them—want to see it continued to be funded. -Key populations to target are physically disabled and homeless individuals.

Priority 1. TTC will continue to provide the full continuum of SUD treatment services in the community with an emphasis on providing targeted outreach and engagement activities to TAY youth, homeless individuals and LGBTQ community.

Mental Health services are considered vital and often in connection with

SUD treatment.

(46% agreed) -Depression hinders people already at risk for chronic diseases, as a barrier to improving health. -Stigma of MH issues also prevents seeking care. -Significant MH issues present in children, but there is still limited specialty youth MH services available. -Limited access to qualified & culturally competent MH professionals.

-MH services seen as imperative to sobriety -Key is to focus on MH treatment/counseling for recurring substance users to prevent relapse.

Priority 2. TTC will continue to provide the full continuum of MH treatment services to address stigma and serious mental illness (SMI) in the community with an emphasis on increasing community knowledge and access to underutilized programs for children and youth such as EPSDT, PEI and mild to moderate services. Priority 3. TTC’s will assign to the existing CLAS Standards subcommittee the task of developing a plan to increase TTC’s staff cultural competency via on-going CLAS standards staff training and development of a hiring and retention plan to increase TTC’s staff bi-lingual (English/Spanish) language capability

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.

Tobacco (smoking in particular) persists as a

health concern.

(50% agreed) -Briefly mentioned as a significant component risk behaviors for KIs who serve TAY youth. -Considered by some a persistent community health issue.

In focus group discussions, tobacco use was not mentioned as a significant health need.

Priority 4. TTC will continue to implement its current patient tobacco cessation activities with an emphasis on impacting TAY youth and monitor adherence to TTC’s tobacco written policy and procedure.

Housing stock in SPA 2 remains limited and in

poor quality

(43% agreed) -Limited supply of affordable housing and poor quality of housing continues to be a significant issue for those already living in poverty or low wage jobs.

-Need for more sober living facilities where both treatment and housing are met. -Limited affordable options for housing in SPA 2—waiting lists for Section 8 and other sources are still very long.

Out of Primary Scope but TTC will continue to work collaboratively with community partners and refer patients to community partners that provide housing services not provided by TTC such as permanent supportive housing.

Access to food/food security significantly

impacts healthy outcomes for those living

in poverty

(32% agreed) -Availability and costliness of healthy foods is an issue for many communities. -There is also a lack of culturally competent collaborative programs and therefore community education on nutrition.

-Some participants express gratitude for food availability in Residential. -It has helped them maintain healthier living, while receiving treatment, which they would not have had otherwise if not in treatment.

Out of Primary Scope but TTC will continue to work collaboratively with community partners and refer patients to available low cost and free food services such as food pantries.

Dental health is an often forgotten aspect of health care that can

affect many other areas of health

(30% agreed) -High price for premiums is prohibitive –leads to avoidance of necessary care. -Considered a significant need due to the potential cause of serious future health issues and low self-esteem.

-Participants acknowledge effects of substance use on persistent dental health issues.

Out of Primary Scope but TTC will continue to refer TTC patients to available dental care services in the community.

Gang violence/unsafe neighborhoods play a role in involvement in

crime/drugs

(29% agreed) -Multiple references to community violence in terms of “unsafe neighborhoods”---not only affecting community involvement & participation in healthy living (parks,

-Some discussion of experiencing or participating in gang violence in areas participants lived in before coming to residential facility.

Out of Primary Scope but TTC will continue to work collaboratively with community agencies that provide gang involvement services and continue to refer patients to needed services.

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classes, etc.) but also immediate harm upon individuals via gang violence.

Chronic Disease Prevention & Management

(Average of 25% agreed with specific chronic diseases, namely: asthma, cancers, Hep C, and chronic pain; average of 20% agreed obesity, diabetes are a problem)

-Chronic diseases are widespread and severely affect the already vulnerable populations in SPA 1 and 2, often intermingle with prescription pain medication abuse & other SUD/MH issues as well. - Some informants focus on availability and costliness of healthy foods and impact of socio-cultural factors in Latino community (diet and health habits, for example)—an urgent need to continue addressing in culturally competent way. -Obesity leads to many other metabolic diseases that have negative impact on health outcomes. -Continued and improved health education and resources/services that are free or low cost. -KIs consider poverty or lack of resources/income to affect access in the work they do. This eventually leads to lower motivation to seek resources. -KIs also desire collaborative efforts in nutrition, healthy eating classes/demonstrations.

No chronic diseases were mentioned in focus group discussions as a significant health need.

Priority 3 from above focuses on addressing the needs of various racial/ethnic groups. Priority 5. TTC will continue focus on integrating behavioral health and medical care services by focusing on chronic diseases prevalent in the communities we serve (e.g. diabetes, obesity, asthma, high blood pressure, etc.) and it’s interaction with SUD/MH. This includes addressing comorbidity and need to provide integrated and coordinated care via shared electronic charting and regular provider case communication and conferencing. TTC will also focus on providing screening for high HCV and HIV risk behavior and linking eligible patients to HCV, PrEP and PEP treatment when appropriate. Lastly this will include providing HCV, HIV, PrEP and PEP 101 training for both TTC patients and staff. TTC will also educate the general community on the availability of HCV, HIV, PrEP and PEP services at TTC’s primary medical care centers.

Access to Health Care and insurance, especially for undocumented and monolingual individuals/families

(32% agreed) -There are still high prices for health care, making it prohibitive to see doctors.

Access to health care or insurance was not discussed as a significant health need by focus group participants.

Priority 6. TTC will continue to provide benefits assistance to patients including education to under insured and undocumented patients who may

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-Rules of Medi-Cal do not allow some to apply for care, especially undocumented. -Costly medications often lead to conditions going untreated and leading to poor health outcomes. -Barriers: language, culture (emphasizing culturally competent care/services), wait time for appointments between referral and services is still very long (Pts. get discouraged), transportation. -Peer support needed for guidance and education of available resources

be able to access primary medical care and/or behavioral health services via State benefits and/or local benefits such as MyHealthLA. TTC will seek to expand the number of patients seen in SUD treatment services under MyHealthLA. Priority #3 (CLAS Subcommittee) also contributes to meeting the health care access needs of patients who are underinsured and/or undocumented by educating about available benefits and services in the patients language of choice.

Homeless services & outreach continue to be

a need in SPA 2

Not directly addressed in survey

-33% were homeless at some point before admission

-KIs who serve homeless in SPA 2 indicate that transgendered and TAY are in significant need of services, including SUD and MH services. -lack of appropriate TAY housing and supportive services has shown an increase in substance use and being sexually exploited.

There is a desire for mobile shower/bathroom units and outreach vans to visit the Sunland-Tujunga Wash area. -Focus group participants were previously homeless and voiced the need for continued or expanded outreach to the areas along the LA River. -There is a need for connections to treatment services and insurance/Medi-cal/ACA and other simple needs to clean up and get linkages to care and transportation if needed.

Priority #1 and #2 from above will contribute to meeting the need of homeless via outreach and engagement in SUD and/or MH services which are comprehensive and integrated.

Lack of jobs/job training services leads to cyclical

involvement in

Not directly addressed in survey.

-66% of survey were -Significant peer support needed for -Participants acknowledge benefits of Out of Primary Scope but TTC will

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crime/substance use either “disabled/unable to work” or “unemployed”

guidance of parolees to basic necessities of life, especially finding a job, continuing education, and also shelter and legal resources.

AB109, Prop 36 and Project 180, but feel there needs to be more training opportunities available while receiving services at TTC—without a job, there is limited income, and can lead to cycle of drug use and crime, then incarceration.

continue to work collaboratively with community partners who provide vocational training services either on-site at TTC and/or via referral.

Limited and unreliable transportation options

(16% agree) -No transportation or unreliable transportation is a key barrier to accessing care and services at the community level, especially in SPA 1 area.

-Transportation also a significant barrier for participants who seek services but are not able to follow up or miss appointments. -Many hope of some sort of all-in-one service provider with multiple services at one location (transportation tokens, job application help or training, referrals to treatment,--but especially a way of transportation to get to these places)

Out of Primary Scope but TTC will continue to provide patient transportation assistance via existing van fleet and ability to leverage use of bus tokens, bus/metro passes and taxi vouchers in certain service contracts.

Funding for peer support

significantly lacking for those who need it most

Not directly asked in survey. No survey questions referenced peer support.

-There seems to be a need for more, improved and cohesive peer support and overall guidance for individuals released from rehab or who are previously incarcerated. -KIs express that there is just not enough funding for these essential peer support programs to develop relationships and linkages for those who need it most--“more handholding is needed”

-Limited education or guidance for parolees or those released from treatment on what to do or who to see after released—eventually leads to a cyclical behavior of recidivism and/or relapse. -Without peer support, patterns of behavior return to those they know they can “survive” on—e.g., crime and selling drugs.

Priority 1 from above will help address this identified need and theme particularly with the expansion of Peer Recovery support services via Drug Medi-Cal, including peer support for those previously incarcerated.