To: Sonoma County Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera 707-565-4774
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Measure O Agreements and Position Allocations
End
Recommended Action:
Recommended action
A) Authorize the Director of Health Services, or designee, to execute funding agreements and/or amendments approved to form by County Counsel, subject to review and approval as to form by County Counsel, with Sonoma State University and the Cities of Healdsburg, Cotati, Rohnert Park, Petaluma, and Santa Rosa for continued support of mobile crisis services for a total amount not-to-exceed $3,999,144 through June 30, 2025.
B) Adopt a personnel Resolution amending the Department of Health Services Department Allocation List to add 8.00 Full-Time Equivalent positions for the Measure O-funded Crisis Assessment, Prevention, and Education program as detailed in the attached resolution, effective July 23, 2024.
C) Adopt a Resolution authorizing budgetary adjustments to the fiscal year 2024-2025 adopted budget, programming $3,980,013 in Measure O fund balance to support the requested position allocations and additional appropriations for funding agreements. (4/5th Vote Required)
end
Executive Summary:
In November 2020, Measure O passed and created a one quarter-cent sales tax to help protect and expand essential mental health and homelessness services over 10 years countywide.
Today, the Measure O expenditure plan provides $30 million per year in support across five categories; Behavioral Health Facilities; Emergency Psychiatric and Crisis Services; Mental Health and Substance Use Disorder Outpatient Services; Behavioral Health Homeless and Care Coordination; and Transitional and Permanent Supportive Housing.
This item requests authority to expend Measure O funds on expected programming, including a one-time investment of $3,999,144 for fiscal year 2024-2025 in order to expand the 24/7 mobile crisis services for all residents of Sonoma County. This investment includes $1,829,440 in funding previously approved in the fiscal year 2024-2025 recommended budget in addition to the $2,169,704 requested in this item. Additionally, a $1,810,309 ongoing investment for the expansion of staffing in our Behavioral Health school program, Crisis Assessment, Prevention, and Education (CAPE), to increase support to twelve high schools in South County, North County, and the Santa Rosa School District, in addition to the seven high schools currently being served in West County and Sonoma Valley. Staff recommendation has been reviewed and endorsed by central Human Resources.
This item also requests approval of a resolution authorizing budgetary adjustments to the fiscal year 2024-2025 adopted budget, programming Measure O fund balance for fiscal year 2024-2025 costs.
After this programming $7,016,805 will remain available in unprogrammed balance for this section (22052500) of the Measure-O Fund.
Discussion:
Progress of Mobile Support Team Expansion
In response to community interest in expanded mobile crisis services, several cities within Sonoma County have established mobile crisis services that utilize behavioral health and emergency medical service teams as first responders to service calls that do not require law enforcement resources. Along with the DHS Mobile Support Team, the City of Santa Rosa has the inRESPONSE team, the Cities of Petaluma, Cotati, Rohnert Park and the campus of Sonoma State University have the SAFE team, and the City of Healdsburg has the CORE team. The development of these teams has created additional opportunities for the Board of Supervisors’ investment of Measure O funds in mobile crisis services, as well as prepared Sonoma County to meet a new state mandate to provide mobile crisis response to Medi-Cal recipients 24/7.
Effective December 2023, the Department of Health Care Services (DHCS) added a mobile crisis benefit that requires counties to have a call center and toll-free number that anyone experiencing a mental health crisis can call and receive a screening using a state-issued dispatch/triage tool. Staff managing the call center can dispatch a mobile crisis team without law enforcement when it is safe to do so. The call center and field response teams both need to operate countywide and be available 24/7.
The Department is utilizing the DHS Mobile Support Team (MST) and the SAFE, inRESPONSE, and CORE teams to assist with meeting the mandate. Over the past six months, internal MST activities have included:
• Mobile Support Team expanded from 6 to 16 permanent staff positions of various classifications. Staffing is currently supplemented by 11 temporary staff.
• Two staff are on duty in the call center responding to calls 24/7, 365 days a year, with a minimum of one 2-person team to field in-person crisis calls. More teams are available during higher frequency shifts.
• Two additional SUVs have been outfitted to securely transport individuals who are in crisis and need assistance accessing higher levels of care.
On April 16, 2024, MST staff launched the 24/7 call center and a revamped Mobile Support Team with increased hours of operation. As of June 2, 2024, MST was able to begin 24/7 staffing for both the call center and field response teams. DHS staff will continue onboarding and training staff, providing education to the community about how to access these services, and continue efforts to collaborate with our law enforcement partners about how to best utilize the Mobile Support Team with this new model.
The regional programs have agreed to assist the Department with meeting the new Medi-Cal mandated service, and Measure O funding is being requested to serve as gap funding to increase ramp-up across these teams to provide adequate staffing, training, and equipment while providers are being Medi-Cal certified. This gap funding also allows adequate transition time for the benefit to be fully operationalized. The Department is seeking a one-time investment of $3,999,144.00 for fiscal year 2024-2025 for the 24/7 mobile crisis services. This investment includes $1,829,440 in funding previously approved in the fiscal year 2024-2025 recommended budget in addition to the $2,169,704 requested in this item.
Funding request breakdown by city:
|
City |
FY 24-25 Contract |
|
Healdsburg (CORE) |
$ 275,000.00 |
|
Santa Rosa (inRESPONSE) |
$ 1,450,000.00 |
|
Rohnert Park (SAFE) |
$ 932,399.00 |
|
Cotati (SAFE) |
$ 136,449.00 |
|
Petaluma (SAFE) |
$ 1,137,072.00 |
|
Sonoma State University (SAFE) |
$ 68,224.00 |
|
Total Request |
$ 3,999,144.00 |
Behavioral Health School Partnership transitions to CAPE
The Behavioral Health School Partnership - now Crisis Assessment, Prevention, and Education (CAPE) is a DHS program revived and reimagined from previous years of youth programming that was cut in 2018 due to budget constraints, to help meet the mental health needs of youth in our community.
As Measure O funding started to materialize, the Measure O Ad Hoc Committee and DHS staff met several times to discuss the needs of Sonoma County students, teachers, and staff to address the mental health needs of our students. The largest need identified was referrals for students requiring additional support to address needs beyond the capacity of school personnel and outside of the school day. In partnership with the Sonoma County Office of Education, DHS staff developed a program proposal that was reviewed and approved by the Measure O Ad Hoc (which included Supervisor Gore and Supervisor Coursey) on October 11, 2022, and brought to this Board for approval on April 18, 2023. The program includes a multi-phase implementation approach over the subsequent three years.
CAPE is currently providing and will expand school-based behavioral health support and interventions to schools in Sonoma County including:
• Providing schools a direct linkage to Behavioral Health staff in order to expedite referrals for Medi-Cal and Medi-Cal eligible beneficiaries who qualify for services
• Five teams geographically located with phone consultation to cover the whole county
• Utilizing partner CBOs for peer support for families in crisis
• Offering training for school staff in identifying students who may be experiencing behavioral health symptoms and would benefit from a referral to DHS or other community healthcare provider
• Providing consultation with schools on students experiencing urgent behavioral health issues
• Re-instituting in-person response to students experiencing a behavioral health crisis
• Linking to substance use disorder treatment services for youth and young adults
In 24-25 School Year, CAPE will serve:
West County:
• Analy High School
• Laguna High School
Sonoma:
• Sonoma Valley
• Creekside High School
• Adele Harrison
• Alta Mira Middle School
• Hanna Boys Center
DHS staff is now requesting to add 8.0 FTE over two years for the next phase of the program.
Adding 8.0 FTE permanent staff positions, including 4.0 FTE Behavioral Health Clinicians and 4.0 FTE Alcohol and Other Drug Services Counselor II, will enable staff to cover these schools in West County and Sonoma Valley, and to expand to South County, North County, and Santa Rosa. Ideally all staff will be in place by the end of FY 24-25 to be ready for expansion the 2025-2026 school year.
CAPE will have 5 teams of 1 clinician and 1 AODS counselor. The additional positions will allow us to serve north county (Cloverdale, Healdsburg, Geyserville), south county (Petaluma, Casa Grande, Rancho) and Santa Rosa City Schools. CAPE will focus on high schools, and if capacity permits, expand services to middle schools.
The Behavioral Health Clinicians and AODS Counselors will work with schools to provide crisis response, linkage to mental health treatment services, education about mental health needs in children and youth, prevention and early intervention activities designed to reduce the negative impact of substance use in children and youth, assessment for substance use treatment, and referrals to substance use treatment services.
Strategic Plan:
N/A
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
On May 16, 2023, the Board authorized the Director of Health Services to execute funding agreements with Sonoma State University and the cities of Cotati, Rohnert Park, Petaluma, and Santa Rosa for continued support of mobile crisis services for a total amount not-to-exceed $1,514,440 through June 30, 2024.
On April 18, 2023, the Board A) Adopted a personnel resolution amending the allocation list for the Department of Health Services to add 4.00 full-time equivalent positions for the Measure O-funded Behavioral Health School Partnership effective April 18, 2023, and B) Adopted a resolution authorizing budgetary adjustments to the fiscal year 2022-2023 adopted budget, programming $250,502 in Measure O fund balance to support the requested position allocations.
On September 20, 2022 the Board A) authorized the Director of Health Services, or designee, to execute a revenue agreement with Advocates for Human Potential, Inc. (state contractor) to accept revenue to support local mobile support team programs in the amount of $2,498,898.69, including $1,929,788.69 for infrastructure through June 30, 2025 and $569,120 for limited direct services through February 14, 2023, and to execute amendments and modifications to said agreement; B) authorize the Director of Health Services to execute funding agreements with the cities of Cotati, Rohnert Park, Petaluma, and Santa Rosa for a total amount not-to-exceed $2,248,787 through June 30, 2025; and C) adopted a resolution authorizing budgetary adjustments to the fiscal year 2022-2023 adopted budget to program funding available to support the Crisis Care Mobile Units Program in the amount of $1,829,099.
On October 26, 2021 the Board A) accepted a staff report on Mobile Support Team (MST)/CAHOOTS Programs; B) allocated a one-time investment of $428,000 to Cotati/Rohnert Park and Petaluma each and $85,887 to Santa Rosa to assist those jurisdictions in developing their MST program for a total of $941,887, and authorized the Interim Director of Health Services to enter into funding agreements with the jurisdictions; and C) directed staff to lead collaborative evaluation in January - December 2022 of all mobile crisis support programs using evaluation criteria suggested, and determine path forward for most sustainable and successful model to adapt and scale countywide.
Fiscal Summary
|
Expenditures |
FY24-25 Adopted |
FY25-26 Projected |
FY26-27 Projected |
|
Budgeted Expenses |
$1,829,440 |
$1,741,018 |
$1,793,249 |
|
Additional Appropriation Requested |
$3,980,013 |
|
|
|
Total Expenditures |
$5,809,453 |
$1,741,018 |
$1,793,249 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
|
|
|
|
Fees/Other |
|
$1,741,018 |
$1,793,249 |
|
Use of Fund Balance |
$5,809,453 |
|
|
|
General Fund Contingencies |
|
|
|
|
Total Sources |
$5,809,453 |
$1,741,018 |
$1,793,249 |
Narrative Explanation of Fiscal Impacts:
The Department is requesting $3,980,013 in appropriations for FY 24-25 to cover $1,810,309 in FY 24/25 staffing costs and $2,169,704 in FY 24/25 funding agreements with 24/7 mobile crisis services partners. The $1,810,309 in staff costs include $1,690,309 in salaries, benefits, and overhead costs and $120,000 in one-time costs* and incentives for 8.0 FTEs. A 3% COLA is assumed for these labor costs in subsequent years, totaling $1,741,018 in FY 25-26 and $1,793,249 in FY 26-27. The request of $2,169,704 in appropriations for FY 24-25 will cover 24/7 mobile crisis services funding agreements with the aforementioned partners.
Fund balance from accumulated Measure O tax receipts (Category 2A) will be used to pay for these expenses in FY 24/25. Future year expenditures will be covered by Measure-O funds received in that fiscal year and will be included via the annual budgetary process.
*Note: One-time charges for newly added employees are FF&E (Furniture, Fixtures & Equipment) costs that include cubicle setup, chairs, and computer equipment, etc.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
Behavioral Health Clinician |
$8,212.82-$9,981.65 |
4.0 |
NA |
|
AODS Counselor II |
$7,070.12-$8,591.98 |
4.0 |
NA |
|
|
|
|
|
Narrative Explanation of Staffing Impacts (If Required):
These are new positions within the Youth and Family Services Section, reporting to the new Behavioral Health School Partnership Health Program Manager. The Department does not have available staff to provide this type of service to youth in the school setting. The new staff will enable the Department to dedicate teams to cover each of the districts in the County.
Attachments:
Attachment 1 - Budget Resolution
Attachment 2 - Personnel Resolution
Attachment 3 - DRAFT CORE Team Scope of Work
Attachment 4 - DRAFT inRESPONSE Team Scope of Work
Attachment 5 - DRAFT SAFE Team Scope of Work
Related Items “On File” with the Clerk of the Board:
None