To: County of Sonoma Board of Supervisors and Board of Commissioners of the Community Development Commission
Department or Agency Name(s): Department of Health Services, Community Development Commission, and Human Services Department
Staff Name and Phone Number: Tina Rivera, 707-565-7876; Michelle Whitman, 707-565-7500; Angela Struckmann, 707-565-6990
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Interdepartmental Multi-Disciplinary Team Staffing Allocations
End
Recommended Action:
Recommended action
A) Adopt a personnel resolution amending the allocation lists for the Department of Health Services, Human Services Department, and the Sonoma County Community Development Commission, effective May 9, 2023, to convert 9.00 full-time equivalent time-limited position allocations to ongoing, extend 1.00 full-time equivalent time-limited position allocation through June 30, 2025, and add 1.00 full-time equivalent position allocation, as detailed in the attached resolution.
B) Adopt a resolution authorizing budgetary adjustments to the Department of Health Services fiscal year 2022-2023 adopted budget, programming $60,000 in Local Indigent Care Needs Implementation Grant funds to support the requested position allocation addition. (4/5th vote required)
C) Authorize the Director of Health Services, or designee, and the Executive Director of the Sonoma County Community Development Commissions, or designee, to execute a memorandum of understanding facilitating payment by the Department of Health Services to the Sonoma County Community Development Commission for Housing Negotiator/Inspector support staffing for the Interdepartmental Multi-Disciplinary Team in an amount not-to-exceed $375,000 for the period July 1, 2023 through June 30, 2025.
(4/5th Vote Required)
end
Executive Summary:
On March 10, 2020, the Board of Supervisors and the Commissioners of the Community Development Commission approved staff recommendation to expand the Accessing Coordinated Care and Empowering Self Sufficiency (ACCESS) Sonoma County initiative to add a permanent Intensive Care Team to respond to homeless encampments. To support this expansion, a total of 10.00 full-time equivalent (FTE) time-limited positions were approved for the Department of Health Services (DHS), Human Services Department (HSD), and the Community Development Commission (CDC) through June 30, 2022. On May 3, 2022 the Board approved the extension of the 10.00 FTE time-limited positions to June 30, 2023.
DHS, HSD, and CDC are now requesting approval to convert 9.00 FTE time-limited positions (DHS - 5.00 FTE, HSD - 4.00 FTE) to ongoing, and extend a 1.00 FTE time-limited position (CDC) through June 30, 2025. All positions will be on the Interdepartmental Multi-Disciplinary Team (IMDT) in DHS, will be included in the DHS budget, and will be funded with local sales tax Measure O revenue. To facilitate payment by DHS to CDC for the cost of the Housing Negotiator/Inspector allocation, this item requests approval to execute a memorandum of understanding between the County (DHS) and CDC in an amount not-to-exceed $332,000 for the period July 1, 2023 through June 30, 2025.
On August 11, 2020, the Board of Supervisors approved a staff recommendation to further expand the ACCESS Sonoma County initiative by adding a 1.00 full-time equivalent time-limited position to develop and implement coordinated continuity of care services for the homeless clients with medical, behavioral health, and substance use disorder challenges as they are released from the County’s Adult Detention Facility and local acute care facilities. The position served as community-wide discharge planner and as a single hub for discharge planners. The Program Planning and Evaluation Analyst (PPEA) allocation was approved through, and expired on, February 28, 2023. DHS is now requesting the addition of an ongoing PPEA allocation for the continuation of community-wide discharge planning efforts. This position will be funded with the Local Indigent Care Needs (LICN) Implementation Grant to June 30, 2024 and Measure O thereafter. Fiscal year 2022-2023 funding appropriations for the PPEA allocation in the amount of $60,000 are being requested via the attached budget resolution.
This report provides information on recent activities of the IMDT, including support for the requested position conversions, extensions, and additions.
Discussion:
California has a homelessness crisis. California has an estimated 161,500 people experiencing homelessness. In the 2018 Point in Time Homeless Count, Sonoma County counted 2,996 people as experiencing homelessness on a single day. The 2019 Homeless Count found an eleven percent increase over the 2018 count. Like other jurisdictions throughout California, high housing costs, low vacancy rates, and displacements due to the recent wildfire disasters are contributory factors to the high rates of homelessness in Sonoma County. The homeless count report issued in mid-2020 saw a slight decrease in total homelessness down to 2,745 experiencing homelessness. A 2021 Count was not conducted due to COVID-19, but those figures were likely exacerbated due to the pandemic compounding recovery from earlier disasters. Consistent with expectations that COVID-19 would adversely impact individuals experiencing and at risk for homelessness, the 2022 count yielded 2,893 individuals experiencing homelessness.
Homelessness is a complex, dynamic, and all-consuming crisis for those experiencing it. Local jurisdictions like Sonoma County have provided most of the homeless assistance in our jurisdictions, relying in part on County General Fund and federal and state funding.
For the last few years, the state has made its largest one-time investments in combatting homelessness in state history. The Homeless Emergency Aid Program (HEAP) and the Homeless, Housing Advocacy Program (HHAP) have in combination allocated $1.15 billion in flexible funds to local governments. The California Interagency Council on Homelessness (CAL ICH) issued a Notice of Funding Availability (NOFA) on December 1, 2022 for $237,301,738 in funding as part of the Encampment Resolution Funding Program (ERF). DHS submitted a competitive application for a portion of these funds. In 2023, an additional $7.5 million is expected from HHAP for the County of Sonoma and the Continuum of Care as well as an additional $10 million from the new State of California Homeless Housing Incentive Program (HHIP) administered by Partnership HealthPlan of California. Despite these investments and funding opportunities, Sonoma County and other local jurisdictions are still faced with gaps in services, sheltering, and housing resources that are desperately needed to address the County’s homeless crisis.
The Interdepartmental Multi-Disciplinary Team (IMDT) and ACCESS Sonoma Initiative have been a key component in the County’s response in addressing homelessness. The IMDT is a care coordination and advisory team of subject matter experts of frontline staff across departments and programs that develops integrated care plans through collaborative planning of individualized goal setting for participants. The IMDT Expansion team has been a key component of supporting the IMDT cohorts, specifically in the Homeless Encampment and Resource Team (HEART), conducting outreach and engagement into services at encampments in the County, as well as with the new Homekey cohort supporting those experiencing homelessness at cities and Homekey sites across Sonoma County.
Since creation of the HEART team, the Expansion team has participated in and been deployed with HEART staff to 75 different encampments connecting individuals to supportive services, resources, shelter, and case management.
In support of the Homekey cohort, IMDT Expansion staff have provided outreach, referral, and intensive case management for all staying at the Non-Congregate Shelters (NCS) set up in response to COVID. This includes providing support in transitioning NCS guests to Project Homekey sites (Elderberry Commons and Mickey Zane Place), accessing Housing Authority Lottery along with other shelter and housing options. The COVID and Homekey cohorts have been supported by IMDT Expansion staff, and collectively have served over 640 people who have accessed NCS sites since they began operating in early 2020.
The 1.0 full-time equivalent position allocation of a Program Planning and Evaluation Analyst (PPEA) that expired in February of 2023 is being requested as this position has helped many across the County to plan and coordinate continuity of care resulting in improved health outcomes for our homeless and high-needs residents being discharged from inpatient treatment. This position works closely with County and community service agencies who are working with the County’s general homeless and high-needs populations and is an active member of ACCESS Sonoma IMDT. A primary focus of this position is to work with care managers to find housing and/or shelter for homeless individuals who are discharged from inpatient care and prevent those individuals who are homeless at time of inpatient discharge from returning to homelessness and to improve their health outcomes. A survey of the community agencies that referred the homeless to the PPEA, showed that majority of respondents felt the PPEA had improved client care coordination to a great extent and had improved system efficiencies and reduced lapses in care for clients being discharged from health and justice settings. Respondents shared that emergency department utilization for non-emergency care had been reduced as a result of the PPEA’s work and that their clients were being effectively linked and re-linked to community services and supports.
The Department of Health Services and the Community Development Commission (CDC) continue to develop outreach and collaboration with local jurisdictions coordinating with the local city staff homeless subcommittee members and the city managers. The Homekey cohort is in the process of hiring staff and meeting to develop possible shared staffing, program resources and similar efforts that will result in greater alignment of efforts to address homelessness. These efforts include participation in a redevelopment of the front-end access to the system of care being coordinated by the CDC, in partnership with a nationally recognized consultant, Homebase, aimed to align efforts across all the County jurisdictions while completing the region’s Homelessness Strategic Plan. The Strategic Plan was finalized in December 2022 and approved by the Continuum of Care Board. In January 2023, the final plan was presented to the Board of Supervisors. The strategic plan will include improving the front-end system components of street outreach, case conferencing, Coordinated Entry, a Countywide By Names List, and exits from institutional settings. DHS and IMDT are participating in these processes to ensure coordination and synchronicity of the IMDT efforts while reconfiguring these systems for effectiveness and efficiency.
DHS, HSD and CDC recommends the conversion of 9.00 FTE time-limited positions to ongoing, the extension of 1.00 FTE time-limited position through June 30, 2025, and the addition of 1.00 FTE allocation, as detailed in the attached resolution. All time-limited positions for which an extension or conversion to ongoing is being requested have a current time-limited term through June 30, 2023. Fiscal year 2023-2024 funding information for each position allocation is provided in the table below.
Position Funding for IMDT Positions:
|
Position |
Dept. |
FTEs |
FY 23-24 Cost ($)* |
Funding Source(s) |
|
Health Program Manager |
DHS |
1.00 |
$217,836 |
Measure O |
|
Behavioral Health Clinician |
DHS |
1.00 |
$192,215 |
Measure O |
|
AODS Counselor II |
DHS |
2.00 |
$337,245 |
Substance Abuse Prevention and Treatment Block Grant (SABG) and Measure O |
|
Public Health Investigator |
DHS |
1.00 |
$150,987 |
Measure O |
|
Senior Eligibility Specialist |
HSD |
1.00 |
$154,648 |
Measure O |
|
Social Service Worker III |
HSD |
2.00 |
$323,308 |
Measure O |
|
Social Service Supervisor I |
HSD |
1.00 |
$185,819 |
Measure O |
|
Housing Negotiator/Inspector |
CDC |
1.00 |
$173,180 |
Measure O |
|
Program Planning and Evaluation Analyst |
DHS |
1.00 |
$195,713 |
LICN Grant and Measure O |
|
Totals |
|
11.00 |
$1,930,951 |
|
*Costs includes salary, benefits, and associated staff costs.
References:
Measure O Expenditure Plan - <https://sonomacounty.ca.gov/health-and-human-services/health-services/divisions/behavioral-health/about-us/measure-o/expenditure-plan>
Local Indigent Care Needs grant- <https://cmspcounties.org/grants-information/>
Strategic Plan:
Implementation of this item will assist in achieving several goals and objectives of the Healthy and Safe Communities pillar of the Strategic Plan. Sonoma County has utilized the ACCESS Sonoma’s Interdepartmental Multi-Disciplinary Team (IMDT) technology, infrastructure, and its specialized cohorts of staff to effectively respond to and support those experiencing homelessness, conducting outreach, engagement and case management. This investment to support our impacted community is designed to, and proven effective at, streamlining access, improving service integration, and bolstering opportunities for coordination of care. In addition, this item will continue the County’s innovative responses to homelessness, by addressing gaps in services that have not supported the most vulnerable or otherwise un-inclined to accept traditional shelter services. The work presented here reflects both existing and future efforts of the IMDT. The IMDT is poised to implement these efforts, continuing progress in attaining the goals and objectives of the Strategic Plan.
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 3: Create a “no wrong door” approach where clients who need services across multiple departments and programs are able to access the array of services needed regardless of where they enter the system.
Prior Board Actions:
On January 31, 2023 the Board adopted a resolution supporting the Sonoma County Continuum of Care’s Regional Strategic Plan on Homelessness for 2023-2027.
On May 3, 2022 the Board adopted a personnel resolution amending the allocation lists for the departments of Health Services and Human Services and the Sonoma County Community Development Commission to extend 10.00 full-time equivalent time-limited positions to June 30, 2023, as detailed in the attached resolution, effective May 3, 2022.
On August 11, 2020 the Board A) approved a grant agreement with the County Medical Services Program Governing Board to accept $1,500,000 in revenue to develop and implement coordinated continuity of care services for homeless clients with medical, behavioral health, and substance use disorder challenges as they are released from the County’s Adult Detention Facility and local acute care facilities for the period July 1, 2020 through September 28, 2023; B) approved a grant agreement with the County Medical Services Program Governing Board to accept $997,243 in revenue to support the County’s COVID-19 response by expanding service delivery, with a focus on homeless individuals, for the period June 1, 2020 through November 30, 2021; and C) adopt a personnel resolution amending the Department of Health Services allocation list, effective August 11, 2020, to add 1.0 full-time equivalent time-limited Program Planning and Evaluation Analyst position through February 28, 2023.
On March 10, 2020 the Board of Supervisors and Board of Commissioners of the Community Development Commission approved a number of actions including A) approved staff’s recommendation to expand the ACCESS Sonoma County Initiative to add a permanent Intensive Care Team to respond to homeless encampments and B) adopted a resolution amending the allocation list for the departments of Health Services and Human Services, and the Community Development Commission adding 10.00 full-time limited term equivalent positions effective March 10, 2020.
Fiscal Summary
|
Expenditures |
FY 22-23 Adopted |
FY 23-24 Projected |
FY 24-25 Projected |
|
Budgeted Expenses |
$103,616 |
$2,000,000 |
$2,000,000 |
|
Additional Appropriation Requested |
$60,000 |
|
|
|
Total Expenditures |
$163,616 |
$2,000,000 |
$2,000,000 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
$163,616 |
|
|
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
$163,616 |
$2,000,000 |
$2,000,000 |
Narrative Explanation of Fiscal Impacts:
Local Indigent Care Needs Implementation Grant funding for the requested PPEA position, in the amount of $60,000, will be added to the FY 2022-2023 budget via the attached resolution. Appropriations for future years will be included in the appropriate year budgets.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
Health Program Manager (DHS) |
$7,692.78 - $9,350.30 |
0.00 |
0.0 |
|
Behavioral Health Clinician (DHS) |
$6,791.84 - $8,254.56 |
0.00 |
0.0 |
|
AODS Counselor II (DHS) |
$5,765.67 - $7,009.24 |
0.00 |
0.0 |
|
Public Health Investigator (DHS) |
$4,991.70 - $6,068.30 |
0.00 |
0.0 |
|
Senior Eligibility Specialist (HSD) |
$5,151.71 - $6,261.36 |
0.00 |
0.0 |
|
Social Service Worker III (HSD) |
$5,454.34 - $6,631.82 |
0.00 |
0.0 |
|
Social Service Supervisor I (HSD) |
$6,504.86 - $7,904.97 |
0.00 |
0.0 |
|
Housing Negotiator/Inspector (CDC) |
$5,520.43 - $6,711.83 |
0.00 |
0.0 |
|
Program Planning and Evaluation Analyst (DHS) |
$6,753.57 - $8,209.34 |
1.00 |
0.0 |
Narrative Explanation of Staffing Impacts (If Required):
8.0 FTE of the 10.00 FTE time-limited IMDT Expansion positions being extended or converted to ongoing are currently filled. Should the Board not approve converting the positions to ongoing, authority to implement layoff procedures will be requested in June as part of the FY 2023-2024 budget adoption process.
The PPEA allocation, which expired on February 28, 2023, was filled by staff who is temporarily underfilling a System Software Analyst position. Should the Board not approve the addition of the new PPEA allocation, the authority to implement layoff procedures will be requested in June as part of the FY 2023-2024 budget adoption process.
Attachments:
Attachment 1 - Personnel Resolution
Attachment 2 - Budget Resolution
Related Items “On File” with the Clerk of the Board:
None