To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Jennifer Solito, 707-565-4774
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
California Department of State Hospitals Diversion Program
End
Recommended Action:
Recommended action
A) Adopt a Resolution amending the Department of Health Services position allocation list to convert 3.40 full-time equivalent time-limited position allocations to ongoing to support the Mental Health Diversion Program (2.4 FTE) and the Finance unit (1.0 FTE), as detailed in the attached resolution, effective October 15, 2024.
B) Adopt a Resolution authorizing budgetary adjustments to the fiscal year 2024-2025 adopted budget, programming $447,317 in California State and Federal funds associated with the requested position allocations.
(4/5th Vote Required)
end
Executive Summary:
The California Department of State Hospitals (CDSH) Diversion Program is a collaboration between CDSH and county governments to develop or expand diversion programs for individuals with serious mental illness who face felony charges and could be determined to be incompetent to stand trial. The need for a Mental Health Diversion program, which allows some people with mental health issues to receive treatment in lieu of prosecution and jail when they are charged with a crime, was initially implemented as a pilot program in fiscal year 2018-2019 and has subsequently been established as a permanent program through the Budget Trailer Bill SB184 Chapter 47 along with 2022 Budget act.
The Sonoma County Department of Health Services (hereinafter, “DHS” or “the Department”) is requesting to convert 3.40 time-limited positions (2.4 FTE Diversion Program positions expiring on November 15, 2024 and 1.0 Finance unit position expiring on December 31, 2024) to permanent ongoing given CDSH has shifted from Pilot Based Funding to Permanent Funding for this program. This new contract and payment structure began July 1, 2024.
This item includes a request for approval of a resolution authorizing budgetary adjustments to the fiscal year 2024-2025 adopted budget to reflect additional revenues and expenditures associated with the requested position allocations in the amount of $447,317.
Discussion:
Mental Health Diversion Program
The State Hospital system is significantly impacted by the number of individuals referred to them with felony charges and incompetent to stand trial designations. Sonoma County was one of 15 counties with the highest rate of these referrals. CDSH made funding available to these counties to fund pilot diversion programs designed to reduce the number of individuals needing placement in the State Hospital system.
These services are a high priority for the Department. They are a part of an overall initiative involving the Sheriff’s Office and the Probation Department to divert individuals with mental illness from the criminal justice system into the healthcare system. This program also supports collaboration between the other safety-net departments, such as Public Defender, District Attorney, and Superior Court.
There are currently no community-based providers providing treatment in-lieu of prosecution services necessary to support the Mental Health Diversion program. On June 30, 2024, DHS’s pilot project for mental health diversion ended. DHS is finalizing a contract with CDSH currently, with a start date of July 1, 2024. These 2.4 FTE positions would be funded on an ongoing basis through this contract with a term of 5 years, ending on 6/30/29 with two (2) one-year extensions if funding remains available in the state’s annual budget.
The CDSH Diversion Program provides state funding to counties to primarily serve individuals who are:
• Eligible for diversion under Penal Code Section 1001.35, et. seq., Diversion of Individuals with Mental Disorders;
• Diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder;
• Charged with a felony; and
• Not a significant safety risk if treated in the community.
In addition, there must be a significant link between the individual’s mental illness or homelessness and the crime they are charged with.
To be considered for the permanent program, a county must contract with CDSH for a CDSH Felony Mental Health Diversion Program. A referral to a county-run diversion program may be made by the defense attorney, the district attorney, the court, or the county diversion provider but only a judge can order a person into a CDSH Felony Mental Health Diversion program. If a person is successful in the program, the current offense(s) that the defendant is charged with and that led to the arrest may be dismissed and dropped from their record.
Once ordered into outpatient treatment in the mental health diversion program, a team of four clinicians provide these services at a treatment clinic in Santa Rosa until they successfully complete the terms of Diversion Court.
The Behavioral Health Clinician position provides specialty mental health services. The services include assessments, treatment planning, motivational counseling, and crisis intervention.
The Senior Client Support Specialist position provides specialty mental health services. The services include case management, mental health rehabilitation services, crisis intervention, and links to other needed services.
The Psychiatric Nurse position provides specialty mental health services. The services include assessment of overall health needs, assessment of mental health needs, assessment of clients’ response to medications, taking vital sign measurements, and assisting with medication management.
The Staff Psychiatrist position provides specialty mental health services. The services include psychiatric assessment, medication management, and consultation with members of the treatment team.
On September 10, 2019, the Board approved the addition of 2.4 time-limited full-time equivalents (FTE), and then extended the same time-limited FTEs on January 10, 2023 and again on October 17, 2023 for this program. The time-limited FTEs include 1.0 Senior Client Support Specialist, 1.0 Behavioral Health Clinician, 0.2 Staff Psychiatrist, and 0.2 Psychiatric Nurse. DHS is currently recruiting for the partial positions that may get bundled with other roles depending on the applicant’s skills and licensure. The full-time positions are currently filled. Prior funding for these positions was CDSH Pilot funding.
Fiscal Unit Staffing
Having the appropriate number of Fiscal staff to manage the transformation of Behavioral Health services under CalAIM and DMC-ODS is critically important for providers and the community we serve. Management is requesting time-limited staffing be converted to ongoing to provide these services to the Behavioral Health Division of the Department of Health Services.
On November 16, 2021, the Board approved 1.0 FTE time-limited Department Analyst to provide fiscal support specific to CalAIM Projects and Reforms requirements for a period of three years ending on December 31, 2024, funded by CalAIM dollars and one-time use of Intergovernmental Transfer fund balance.
The 1.0 Department Analyst position (currently filled) provides project support in the CalAIM-required areas including changes with DMC-ODS and payment reform, streamlined administrative functions, opportunities for regional contracting, updating the SUD Outpatient Delivery System (ODS), training/transition/coding changes in IT Avatar/SWITS updates and support for privacy and compliance.
Fiscal Year 2024-2025 Budget Appropriations
This item includes a request for approval of a resolution authorizing budgetary adjustments to the fiscal year 2024-2025 adopted budget to reflect additional revenues and expenditures associated with the requested position allocations in the amount of $447,317.
Strategic Plan:
N/A
Prior Board Actions:
On October 17, 2023, the Board A) Adopted a personnel resolution amending the Department of Health Services position allocation list to extend 2.40 full-time equivalent time-limited position allocations through December 31, 2024 to support the Mental Health Diversion program, as detailed in the attached resolution, effective October 17, 2023; and B) Adopted a resolution authorizing budgetary adjustments to the fiscal year 2023-2024 adopted budget, programming $469,000 in 1991 Mental Health Realignment to finance costs associated with the requested position allocations.
On January 10, 2023 the Board A) adopted a personnel resolution amending the Department of Health Services allocation list to extend 2.40 full-time equivalent time-limited position allocations through October 2, 2023 to support the Mental Health Diversion program, extension effective December 1, 2022 and B) adopted a resolution authorizing budgetary adjustments to the fiscal year 2022-2023 adopted budget, programming $205,380 1991 Mental Health Realignment finance cost associated with the requested position allocations.
On November 16, 2021 the Board A) Received a report on the California Advancing and Innovating Medi-Cal (CalAIM) multi-year initiative; B) Approved the County’s participation as an Enhanced Care Management (ECM) provider and authorize the Health Services Interim Director, or designee, to enter into an agreement with Partnership HealthPlan of California (PHC) to provide ECM services to PHC referred members at the Per Enrollee Per Month (PEPM) contract rates; C) Adopted a personnel resolution amending the Department of Health Services allocation list, adding a 1.00 time-limited full-time equivalent Program Planning and Evaluation Analyst position and a 1.00 time-limited full-time equivalent Department Analyst position, effective November 16, 2021; and D) Adopted a resolution authorizing budgetary adjustments to the fiscal year 2021-2022 adopted budget by increasing revenues and expenditures in the Department of Health Services by $266,980 to support additional position allocations for the remainder of the fiscal year.
On September 10, 2019, the Board adopted a personnel resolution effective September 10, 2019 adding 13.70 full-time equivalent positions for Behavioral Health Division. This action included approval of the time limited 2.40 FTEs specifically for California Department of State Hospitals funded diversion program.
Fiscal Summary
|
Expenditures |
FY 24-25 Adopted |
FY 25-26 Projected |
FY 26-27 Projected |
|
Budgeted Expenses |
|
$870,464 |
$905,283 |
|
Additional Appropriation Requested |
$447,317 |
|
|
|
Total Expenditures |
$447,317 |
$870,464 |
$905,283 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
$447,317 |
$870,464 |
$905,283 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
$447,317 |
$870,464 |
$905,283 |
Narrative Explanation of Fiscal Impacts:
The time-limited 2.40 FTE of Diversion staff are currently scheduled to end on December 31, 2024, and thus, were budgeted for only the first six months of FY 24-25. DHS is requesting appropriations estimated to be $303,195 for the remaining six months of FY 24-25 in Diversion staff costs to convert these positions to full-time, permanent positions. CDSH has allocated full, permanent funding for the 2.40 FTEs in Diversion staff now that the pilot program has completed and is replaced by an ongoing full-time program.
The 1.0 time-limited Finance department analyst is currently scheduled to terminate on November 15, 2024, and was budgeted for that period only. DHS is requesting appropriations estimated to be $144,123 for the remaining 7.5 months of FY 24-25, to convert this position to full-time, permanent FTE. Ongoing Medi-Cal reimbursements as well as upcoming Drug Medi-Cal Organized Delivery System (DMC-ODS) reimbursements will cover the full cost of this position on an ongoing basis.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
2470, Senior Client Support Specialist |
6,664.87 - 8,101.50 |
0 |
0 |
|
2503, Behavioral Health Clinician |
8,212.82 - 9,981.65 |
0 |
0 |
|
2534, Staff Psychiatrist |
21,679.96 - 26,349.89 |
0 |
0 |
|
2091, Psychiatric Nurse |
10,042.53 - 12,206.17 |
0 |
0 |
|
0826, Department Analyst |
7,718.87 - 9,383.34 |
0 |
0 |
Narrative Explanation of Staffing Impacts (If Required):
There will be no staffing impacts because the job class allocations will not change. This is a Time-Limited conversion to Ongoing request only.
Attachments:
Attachment 1 - Personnel Resolution
Attachment 2 - Budget Resolution
Related Items “On File” with the Clerk of the Board:
None