To: Board of Supervisors of Sonoma County
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera, 565-4774
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Behavioral Health Division Staffing Allocations
End
Recommended Action:
Recommended action
A) Adopt a personnel resolution amending the Department of Health Services allocation list to add 12.0 full-time equivalent time-limited position allocations, add 1.0 full-time equivalent allocation, and delete one full-time equivalent allocation in the Behavioral Health Division as detailed in the attached resolution, effective February 8, 2022.
B) Adopt a budget resolution authorizing budgetary adjustments to the fiscal year 2021-2022 adopted budget to reflect additional revenues and expenditures related to additional position allocations in the Behavioral Health Division in the amount of $1,150,360.
(4/5th Vote Required)
end
Executive Summary:
The Department of Health Services has identified a need to add 13.0 full-time equivalent position allocations, 12.0 of which will be four-year time-limited, in the Behavioral Health Division to meet client needs, goals, objectives, and strategies. The requested positions will be funded by Mental Health Services Act (MHSA) fund balance ($460,726), Behavioral Health Stabilization fund balance ($1,120,506) and Driving Under the influence fees ($29,857). This item also requests the deletion of a vacant 1.0 full-time equivalent Senior Office Assistant allocation. This report provides details regarding the need, job duties, and funding of the positions.
Appropriations for the additional position allocations are being requested via the attached budget resolution in the amount of $1,150,360 for fiscal year 2021-2022. Over the four-year period, the Department will use MHSA fund balance of $3.7 million and Behavioral Health Fund Stabilization fund balance of $4 million to fund the positions along with other leverage funding. A breakdown of the annual funding can be found in the Funding Plan Table on Attachment 3. The estimated uncommitted fund balances as of June 30, 2022, are $8.4 million and $11 million, respectively.
Discussion:
The Department of Health Services’ Behavioral Health Division functions as Sonoma County’s Medi-Cal Mental Health Plan (MHP) and Drug Medi-Cal Services provider for Medi-Cal beneficiaries. In these roles, the Department of Health Services (DHS) is responsible for a set of mandates and contractual obligations providing services to adult with severe mental illness, children with serious emotional disturbance and adults and youth with substance abuse disorders. This report provides information regarding the 13.0 full-time equivalent (FTE) position allocations being requested for the Behavioral Health Division, including the need and funding for the positions, to enable DHS to meet its behavioral health services responsibilities.
Family Advocacy Stabilization and Support Team (FASST) Program - 3.0 FTE Behavioral Health Clinicians - Time-Limited Through February 2, 2026
As the Sonoma County Mental Health Plan (MHP), DHS is required to provide services, that are “entitlements” to children and youth under the Early Periodic Screening, Diagnosis and Treatment benefit. As the recipient of Mental Health Services Act (MHSA) funds, DHS is required to provide intensive services to qualifying children and youth via Full Service Partnership (FSP) programs. The FASST program is the DHS child and youth FSP. These services must be intensive and tailored to the unique needs of each child, youth and family. FSPs are described as “do whatever it takes” programs, and DHS offers a set of services via the county operated FASST program and community-based organizations that function as part of the MHP via contracts with DHS. The FASST program, consistent with FSP guidelines, requires that clinicians carry small caseloads, up to 14 for each provider, that allows for a high level of service intensity and flexibility. Maintaining low caseloads allows staff to provide intensive services on an out-patient basis, reducing the need for higher cost interventions such as Crisis Stabilization Unit (CSU) and hospital visits, and placement in residential care facilities. Currently, caseloads in this program range between 22 - 25 clients, and more staff are needed to reduce caseload size and provide required services. Adding these positions will assist in lower caseload sizes for all staff in this program. Lower caseload sizes will assist in providing mandated services, better supporting clients and families and avoiding higher cost crisis and institutional services.
Quality Assessment and Performance Improvement (QAPI) Auditing and Monitoring Team (AMT) - 2.0 FTE Behavioral Health Clinicians - Time-Limited Through February 2, 2026
The DHS Behavioral Health Division has determined that its Quality Assessment and Performance Improvement (QAPI) Auditing and Monitoring Team (AMT) requires increased staffing in order to meet Federal and State requirements associated with auditing programs funded by Medi-Cal, Drug Medi-Cal, and state and federal grants. The requested Behavioral Health Clinicians will function as auditors within the QAPI Section.
The current staffing on the team is inadequate to meet Federal and State requirements for auditing programs that are funded by Medi-Cal, Drug Medi-Cal, and state and federal grants. The Behavioral Health Division is currently on a Corrective Action Plan (CAP) with the Department of Health Care Services (DHCS) to be current with all audits that are past due. The Behavioral Health Clinician job class is required as the auditing activities involve a review of clinical documentation by a licensed/ certified clinician in accordance with the records being audited.
By increasing staffing on AMT, the Behavioral Health Division will be able to meet federal and state requirements related to auditing BH programs. This will reduce the Division’s risk of future CAPs and/or sanctions and fines. Without the appropriate staffing on this team, there is greater continued exposure to audit risks that result in recoupments of both federal and state funding.
Foster Youth Team (FYT) - 3.0 FTE Behavioral Health Clinicians - Time-Limited Through February 2, 2026
New state mandates require that all children in the child welfare system are assessed using the Integrated Practice Child and Adolescent Needs and Strengths (IP-CANS) tool, in order to determine any need for mental health treatment, and to inform case plans made during Child and Family Team (CFT) meetings. Human Services and Behavioral Health agree this assessment should be completed by Behavioral Health clinical staff. Behavioral Health will need to add 1.0 FTE Behavioral Health Clinician to complete the approximately 1,200 IP-CANS per year.
New federal mandates require all children being considered for placement in a Short-Term Residential Treatment Program (STRTP) have a throughout assessment (QI assessment) completed by a Qualified Individual (QI) who is not part of their on-going service provision team. These assessments will be used to determine if there are any alternatives to residential placement, and to make recommendations about residential placement. Completing these assessments is the responsibility of the Behavioral Health Division. In order to complete these assessments for all children being considered for placement in an STRTP, or who have been placed on an emergency basis, who are changing from one STRTP to another, or who have been in an STRTP longer than 6 months, Behavioral Health will need to add 2.0 FTE Behavioral Health Clinicians. DHS is not currently able to meet this mandate with current staffing allocations to complete the 25-50 QI STRTP assessments per year.
Foster Youth Team - 1.0 FTE Office Assistant II - Time-Limited Through February 2, 2026
DHS has responsibility to convene Child and Family Team (CFT) meetings for children, youth and families served by DHS and the Human Services Department. Convening these meetings will require scheduling clients, families, and staff from partner agencies for quarterly meetings. It is estimated there will be 1,200 such meetings per year. This position is needed for scheduling those meetings, and providing clerical support to the process.
Office Assistant IIs perform supportive duties for the assigned program which includes, but is not limited to, the following: assist clients and members of the public by answering phones and responding to questions; assist with preparing and maintaining program and/or client files; maintain and process a variety of records and transactions; enter and retrieve data from electronic data processing systems; compile information to be used in reports; operate a variety of office machines and equipment; scheduling appointments; perform various office/clerical related tasks and attend meetings and/or trainings.
Foster Youth Team - 1.0 FTE Senior Client Support Specialist - Time-Limited Through February 2, 2026
The Senior Client Support Specialist will support the new mandate for Youth and Family Services to carry out Child and Family Team meetings for children open to services. The Department is required to be in compliance with state requirements to carry out Child and Family Team (CFT) meetings for children open to services. This position is needed to carry out this responsibility.
Family Advocacy Stabilization and Support Team (FASST) and Transitional Age Youth (TAY) will have to do CFTs four times per year for each client. The Foster Youth Team (FYT) has to do them twice a year for FYT clients. (The Human Services Department does the other half of the CFTs on those clients). Approximately 1,200 CFTs per year will need to be done between the three programs. A full-time Senior Client Support Specialist can do eight CFTs per week, which would be about 1,100 CFTs per year if we add the requested position to the two existing full-time equivalent Senior Client Support Specialists.
Crisis Stabilization Unit (CSU) - 2.0 FTE Client Support Specialists - Time-Limited Through February 2, 2026
This project takes advantage of 2021 Mental Health Block Grant Supplemental funds to create two positions that address a set of DHS priorities: 1) Establish peer support services, which are effective and cost effective, throughout the behavioral health services system; 2) Increase direct client supervision in the CSU to improve client and staff safety; 3) Increase treatment resources within the CSU. The positions add low cost highly effective services that engage CSU clients, increase direct supervision on the floor, improve services and safety, and support DHS and the state’s priority to add peer support services to the mental health system.
Increasing direct client supervision on the CSU floor is a priority to increase client and staff safety. The attention of Nursing Staff and Behavioral Health Clinicians is frequently focused on a high priority activity of the moment (ex., administering medication, addressing a client outburst, etc.). In these instances, it is critical to have adequate staffing directly observing and intervening with the client group on the floor. These positions will better allow nurses and clinicians to provide the specialized services associated with their training and licenses.
Substance Use Disorder Services (SUDS) and Driving Under the Influence (DUI) Program - 1.0 FTE Office Support Supervisor (delete 1.0 FTE Senior Office Assistant)
Currently, the majority of administrative duties and coordination relating to program staff for the entire SUDS section has fallen on two full-time Senior Office Assistants, leading to the necessity for the hiring of temporary staff. Each time an employee is out of the office or on leave, it leaves a tremendous burden on internal staff, and often puts the Section Manager in a difficult position, pulling her away from her primary duties which are also impacted while the Department recruits to fill two Health Program Manager vacancies. This has created a critical bottleneck in completing high priorities tasks, and leads to delayed projects and requested deadline extensions. This gap in support does not allow for proper training and development for staff to build a stronger foundation of support for the section.
In addition, with passage of Measure O and in preparation of entering the Drug Medi-Cal Organized Delivery System (DMC-ODS) waiver, the Substance Use Disorder and Recovery Services section is about to enter an intense planning and expansion period that will require substantial administrative coordination and support.
In order to address these issues and better support the needs of the Division and the Department, the Behavioral Health Division Substance Use Disorder and Administrative Support team will need to expand and reorganize to address the significant needs associated with all substance use disorder services and programs. Due to the nature of SUD services and programs, and the current structure, the need for an Office Support Supervisor (OSS) is critical to the success in assigning and delegating responsibilities across all programs, as Senior Office Assistants (SOAs) and Office Assistants (OAs) provide support across multiple programs within the SUDS Section and the DUI Program, and are not assigned by a specific program. This restructuring of the OSS as the supervisor for clerical support will transfer supervisorial responsibilities of at least eight staff members from the Section Manager to the OSS; thereby allowing the Section Manager to spend her time focusing on bigger projects and strategic initiatives. The OSS will help improve office and program operations by directing clerical staff in their daily administrative tasks, ensuring smooth processes for the projects and programs they are supporting to meet programmatic mandates and requirements, and by assisting with onboarding, training, coaching, and development of clerical staff to build a robust clerical support team to help the division meet its strategic priorities.
This item also requests the deletion of a vacant 1.0 full-time equivalent Senior Office Assistant allocation.
Budget Adjustment Resolution
Appropriations for the additional position allocations are being requested via the attached budget resolution in the amount of $1,150,360 for fiscal year 2021-2022.
Prior Board Actions:
None.
Fiscal Summary
|
Expenditures |
FY 21-22 Adopted |
FY 22-23 Projected |
FY 23-24 Projected |
|
Budgeted Expenses |
|
$2,233,579 |
$2,288,028 |
|
Additional Appropriation Requested |
$1,150,360 |
|
|
|
Total Expenditures |
$1,150,360 |
$2,233,579 |
$2,288,028 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
|
|
$621,028 |
|
Fees/Other |
$29,854 |
$50,223 |
$50,774 |
|
Use of Fund Balance |
$1,120,506 |
$2,183,356 |
$1,616,226 |
|
Contingencies |
|
|
|
|
Total Sources |
$1,150,360 |
$2,233,579 |
$2,288,028 |
Narrative Explanation of Fiscal Impacts:
Family Advocacy Stabilization and Support Team (FASST) Program - 3.0 FTE Behavioral Health Clinicians - The one-time costs of $2,485,668 for four years for the Behavioral Health Clinician/Intern will be funded through the Mental Health Services Act fund balance and leveraged federal financial participation dollars for Medi-Cal Administrative Activities.
Quality Assessment and Performance Improvement (QAPI) Auditing and Monitoring Team (AMT) - 2.0 FTE Behavioral Health Clinicians - The one-time costs of $1,763,485 for four years for the Behavioral Health Clinical Specialists will be funded leveraged federal financial participation dollars and matching Behavioral Health Stabilization fund balance.
Foster Youth Team - 3.0 FTE Behavioral Health Clinicians - The one-time costs of $2,485,668 for three Behavioral Health Clinicians will be funded through leveraging federal financial participation dollars and use of Mental Health Services Act fund balance.
Foster Youth Team - 1.0 FTE Office Assistant II - The one-time costs of $438,505 for four years for the Office Assistant will be funded through the Behavioral Health Stabilization fund balance.
Foster Youth Team - 1.0 FTE Senior Client Support Specialist - The one-time costs of $663,231 for four years for the Senior Client Support Specialist will be funded through the Behavioral Health Stabilization fund balance.
Crisis Stabilization Unit (CSU) - 2.0 FTE Client Support Specialists - The one-time costs of $1,072,313 for two Senior Client Support specialists will be funded through leveraging of Federal Financial Participation dollars and matching Behavioral Health Stabilization fund balance.
Substance Use Disorder Services (SUDS) and Driving Under the Influence (DUI) Programs - 1.0 FTE Office Support Supervisor (delete 1.0 FTE Senior Office Assistant) - The funding of this permanent Office Support Supervisor will be from Driving Under the Influence fees, the Department has an existing vacant Senior Office Assistant allocation that will be deleted.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
Behavioral Health Clinician |
$6,610.95 - $8,037.15 |
8.0 |
0.0 |
|
Client Support Specialist |
$3,843.78 - $4,673.41 |
2.0 |
0.0 |
|
Office Assistant II |
$3,346.35 - $4,066.41 |
1.0 |
0.0 |
|
Office Support Supervisor |
$4,515.14 - $5,487.39 |
1.0 |
0.0 |
|
Senior Client Support Specialist |
$5,047.35 - $6,134.39 |
1.0 |
0.0 |
|
Senior Office Assistant |
$3,812.47 - $4,635.15 |
0.0 |
1.0 |
Narrative Explanation of Staffing Impacts (If Required):
If approved, the Department of Health Services will work with Human Resources to fill the new positions. The Senior Office Assistant allocation being deleted is currently vacant.
Attachments:
Attachment 1 - Personnel Resolution
Attachment 2 - Budget Resolution
Attachment 3 - Funding Plan Table
Related Items “On File” with the Clerk of the Board:
None