To: Board of Supervisors of Sonoma County
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Emilia Gabriele, 707-565-4769
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Mental Health Services Act Innovation Project: Crossroads to Hope
End
Recommended Action:
Recommended action
Approve the Mental Health Services Act Innovation Project: Crossroads to Hope.
end
Executive Summary:
In November 2004, California voters approved Proposition 63, the Mental Health Services Act (MHSA). The Act imposes a one percent income tax on personal income in excess of $1 million. Much of the funding is provided to counties to fund mental health programs consistent with their local plans. The Act states that five percent of the total funding for each county shall be utilized for innovative programs. The average annual revenue over the past five years has been approximately $1.18 million.
Innovative programs are defined as novel, creative, and/or ingenious mental health practices or approaches that are expected to contribute to learning, which are developed within communities through a process that is inclusive and representative of unserved and underserved individuals. The Innovation component allows counties the opportunity to try out new approaches that can inform current and future mental health practices. Innovation projects are subject to one-time funding with time limitations to assess and evaluate their efficacy.
Prior to spending Innovation funds, a county must obtain approval from the state Mental Health Services Oversight and Accountability Commission (MHSOAC). The MHSOAC requires that counties must conduct a 30-day local review process as well as holding a public hearing by the local mental health board. Counties must present and submit documentation that their county Board of Supervisors has also approved the project(s) and the associated expenditures of Innovation component funds.
The Crossroads to Hope (Crossroads) Innovation Project will expand access to housing and community-based treatment for individuals who are eligible criminal justice diversion clients, have a severe mental health illness, and may have co-occurring substance use disorders. Crossroads will serve individuals who are diverted from jail in Crossroad’s transitional housing beds located at 866 Sonoma Avenue in Santa Rosa (secured through a California Health Facilities Financing Authority grant). Crossroads will enhance the multimodal approach for adult diversion clients who are determined to be at-risk for IST (Incompetent to Stand Trial) by adding intensive peer support services for up to six individuals at one time within a six-month transitional housing environment. Crossroads will utilize peer supportive services consisting of a team of peer providers with lived mental health and criminal justice experience who will lead a holistic client-centered program. The Department plans to develop a request for proposals (RFP) and solicit up to a five-year contract with a community-based organization to provide peer-led services for the proposed term of the Innovation funding award.
The Department is asking the Board to approve the proposed Crossroads to Hope MHSA Innovation Project so that the Department may then obtain final approval from the MHSOAC to spend $2.5 million of the County’s Innovation funds over the course of the five-year project period.
Discussion:
Currently, Sonoma County does not have any dedicated housing that provides supportive and recovery driven peer services for individuals with significant mental health and/or substance use disorders and criminal justice involvement. Instead, many individuals that have significant mental health and/or substance use disorders and criminal justice involvement are housed in the Sonoma County jails without supportive peer services and evidenced based treatment designed to move them towards recovery and away from criminal justice involvement.
Crossroads to Hope (Crossroads) is a Department of Health Services Behavioral Health Division Innovation Project that will expand access to housing and community-based treatment for individuals who are eligible criminal justice diversion clients, have a severe mental health illness, and may have co-occurring substance use disorders. Crossroads will enhance the multimodal approach for adult diversion clients who are determined to be at-risk for IST (Incompetent to Stand Trial) by adding intensive peer support services for up to six individuals at one time within a six-month transitional housing environment. Crossroads to Hope will serve six individuals with severe mental health concerns who are diverted from jail in Crossroad’s transitional housing beds located at 866 Sonoma Avenue in Santa Rosa (a six-bed house purchased by the County through a California Health Facilities Financing Authority - Community Services Infrastructure Grant). Assuming a maximum stay of six months, with some clients who will transition to long-term housing earlier or choose to leave the program, it is anticipated that the program will be able to serve 12 to 20 clients each year. The property at 866 Sonoma Avenue was acquired in January of 2020 during the Emergency Response to the Joe Rodota Trail Homeless Encampment. Using the property for the Crossroads to Hope program will serve individuals at risk of homelessness with housing and much needed services. The diversion transitional housing beds will be an invaluable resource for serving the diversion population in the County, by helping clients to focus on their recovery plan, connect to treatment services, and re-engage with the community and secure long-term housing.
Crossroads will utilize peer supportive services consisting of a team of peer providers with lived mental health and criminal justice experience who will lead a holistic client-centered program. The peer support services will focus on the following:
• Supporting recovery and wellness strategies.
• Encouraging independent living skills.
• Building a community of natural supports.
• Accessing community resources.
• Establishing long-term stable housing.
The Department plans to develop a request for proposals (RFP) and solicit up to a five-year contract with a community-based organization to provide peer-led services for the proposed term of the Innovation funding award. Peer providers will collaborate with the County’s Mental Health (MH) Diversion team to support the development of client-driven recovery plans, facilitate educational and support groups, provide navigation for needed community services, and help support the overall well-being of the residents. In addition, the contractor selected through the RFP process will establish and maintain a Community Peer Advisory Council (CPAC) in collaboration with the Behavioral Health Division for the project and participate in the project’s evaluation activities. Peer providers will be responsible for monitoring clients, offering redirection, and reporting any challenges to supervisors and the MH Diversion team when problems occur. Peers will not have the role of addressing compliance issues. In addition, the County plans to contract with an independent evaluator to oversee program evaluation. Subsequent to approval of the project by MHSOAC and completion of the competitive procurement process, the Department will return to the Board to request authority to enter into contracts for services associated with the project.
Peer providers will support client-driven recovery plans, facilitate educational and support groups, provide navigation for needed community services, and help support the overall well-being of the residents. The MH Diversion team will provide intensive case management and individual, group, and family/couples therapy. Education, psychiatry and medication evaluation and monitoring will be provided by a registered nurse, who is also part of the MH Diversion team.
The Behavioral Health Division’s MHSA Coordinator and the Forensic Health Program Manager will share responsibility to monitor the progress of the Crossroads to Hope project and assure contract compliance per County and state regulations for both the program and the evaluation contractors. The County may provide technical support in program delivery and evaluation, fiscal reporting and program reporting to these contractors. Project coordination meetings will be held quarterly to establish expectations in reporting and to assure compliance with MHSA and regulations. In addition, the selected contractor will be expected to submit quarterly reports that include client demographics (as per MHSA Innovation regulations), program data, program progress and challenges, and invoices for services rendered.
From May to November 2021, the Department highlighted the proposal and enlisted feedback from local stakeholders. On January 18, 2022, the Mental Health Board conducted a public hearing and received comment on the proposal. Below is a summarized project timeline. More detailed information on this project can be found in the written proposal, provided as Attachment 1.
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Date |
Activity |
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June 2016 |
Group of community stakeholders identity the lack and need of services and supports for those who were on the precipice of a crisis. |
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April 2018 |
Sonoma County’s Housing Needs Assessment, report recommended the consideration of the types of supports and services needed for individuals with a history of incarceration and/or inpatient psychiatric services. |
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January 2020 |
MHSA’s Sonoma County Capacity Assessment Report states that consumers, as well as providers, expressed support for peer-led programs at all levels of care and community stakeholders praised peer providers and programs noting the effectiveness of engaging individuals into treatment and empowering a community of recovery that could not be achieved by clinicians alone. |
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April - May 2020 |
The County, and a few members and consultants from the Sonoma County Peer Council start the development and planning of Crossroads to Hope. |
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May 2021 - November 2021 |
Crossroads to Hope Innovation proposal is highlighted and presented to various groups of MHSA stakeholders. All comments received were positive. |
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December 1, 2021 |
The publication of the Crossroads to Hope proposal is posted on the Department’s website. |
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January 18, 2022 |
The Mental Health Board hosted the public hearing. Two letters were received and two public comments were made in support of the Crossroads to Hope proposal. |
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February 8, 2022 |
Board approval of the Crossroads to Hope proposal. |
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February 2022 |
Mental Health Services Oversight and Accountability Commission (MHSOAC) approval of the Crossroads to Hope proposal. |
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February 2022 |
Release of request for proposals for peer services contractor. |
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March 2022 |
Release of request for proposals for project evaluator. |
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March 2022 |
Peer services contractor selected through RFP process. |
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March - April 2022 |
County develops contract with Vendor. |
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April 2022 |
Project evaluation contractor selected through RFP process. |
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April - June 2022 |
Contractor recruits Peer Providers, develops Peer Advisory Council and begins training and procedures. |
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June 2022 |
Client enrollment begins. |
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: Increase investment in programs that treat underlying causes of homelessness, including substance abuse, mental illness, poverty, and lack of affordable housing.
This program will provide much needed integrated mental health services and supports and housing for individuals diverted from jail. In addition, it will provide housing and supportive services for individuals with mental health issues that are involved in the criminal justice system and at higher risk for homelessness. The program will provide supportive peer services, mental health treatment, independent living skills, development of natural community supports and housing for up to six months these skills and supports will aid them in securing and maintaining long-term housing. While the clients are in the supportive housing environment they will be provided with expert housing assistance, and the program will provide the funds for deposit and first and last month rent for the client to transition into long-term housing
Prior Board Actions:
On December 7, 2021 the Board adopted the Mental Health Services Act Annual Plan Update and Expenditure Plan for 2021-2022 and Annual Program Report for 2019-2020.
On February 23, 2021 the Board approved the following Mental Health Services Act Innovation project proposals as required by the Mental Health Services Oversight and Accountability Commission: 1) Collaborative Care Enhanced Recovery Project; 2) Instructions Not Included; 3) New Parent Talk-Link-Confirm; and 4) Nuestra Cultura Cura Social Innovation Lab.
Fiscal Summary
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Narrative Explanation of Fiscal Impacts:
There are no direct fiscal impacts associated with this item. A total of $2,500,000 will be used to fund the Crossroads to Hope over the five-year duration of the project. Appropriations for fiscal year 2021-2022 will be added when the Department returns to the Board at a future date to request authority to enter into contract to support the Crossroads to Hope project.
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - Crossroads to Hope Innovation Proposal
Related Items “On File” with the Clerk of the Board:
None