To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera, 707-565-4774
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Measure O Update and Annual Report for Fiscal Year 2021-2022 and Behavioral Health School Partnership Staffing
End
Recommended Action:
Recommended action
A) Receive the Measure O Annual Report for Fiscal Year 2021-2022 as approved by the Citizen’s Oversight Committee for Measure O.
B) Adopt 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 as detailed in the attached resolution, effective April 18, 2023.
C) Adopt 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. (4/5th Vote Required)
(4/5th Vote Required)
end
Executive Summary:
The Citizen’s Oversight Committee for the Behavioral Health and Homeless Services Measure O, on January 18, 2023, approved and is submitting the annual report for FY 2021-2022 associated with the ten-year measure. The Oversight Committee affirms that the expenditures meet the intent of the ordinance. The Oversight Committee has additionally submitted a Committee Review Letter outlining their approval and recommendations for the Board to review. The Measure O Annual Report provides the Board and voters with an update on the programmatic spending and accomplishments of Measure O funding achieved during fiscal year 2021-2022 as administered by the County’s Department of Health Services (hereinafter “DHS” or, “the Department”).
This item also proposes a new program with related staffing - the Behavioral Health School Partnership. This program and the related 4.0 full-time equivalent staff (FTE) are a direct response to both the will of Sonoma County voters via the Measure O Expenditure Plan as well as requests from School District Superintendents from across the County who brought forward their desire to see a new Sonoma County Behavioral Health program developed to address the mental health needs of students.
The Measure O Ad Hoc Committee and DHS staff met in December 2021 and February 2022 to discuss the mental health needs of Sonoma County students, teachers, and school staff. The largest need identified is 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 proposal for the Behavioral Health School Partnership program. The proposal was reviewed and approved by the Measure O Ad Hoc on October 11, 2022. This item includes a request to add staff to support the initial implementation phase of the program.
This item also requests approval of a resolution authorizing budgetary adjustments to the fiscal year 2022-2023 adopted budget, programming Measure O fund balance for the fiscal year 2022-2023 costs.
Discussion:
Background and Annual Report
In November 2020 Sonoma County passed Measure O to provide essential funding for mental health and homeless services with 68.07 percent of the vote. Measure O, a one-quarter cent sales tax, was estimated to generate over $25 million each year for ten years to help protect essential mental health and homelessness services and is one of just two measures for mental health and homeless funding in the state (Mendocino County’s Measure B passed in 2017). The Measure O Sales Tax Ordinance identified five categories of services to be funded with the revenue: 1) Behavioral Health Facilities, 2) Emergency Psychiatric and Crisis Services, 3) Mental Health and Substance Use Disorder Outpatient Services, 4) Behavioral Health Homeless and Care Coordination, and 5) Transitional and Permanent Supportive Housing. The Measure O Expenditure Plan designates a set percentage of funding for each category. The current projection for fiscal year 2023-2024 Measure O revenue is approximately $31 million.
On December 7, 2021 the Board of Supervisors established a Citizen’s Oversight Committee to monitor the implementation of Measure O. On January 18, 2023 the committee voted to confirm that the Measure O Annual Report for Fiscal Year 2021-2022 meets the intent of the measure, conveys to the public how funds were spent by DHS, and appropriately details remaining fund balances for behavioral health and homeless services in future years. The Annual Report includes a table that details Measure O revenue, expenditures, and fund balance ending June 30, 2022. The English version of the Measure O Annual Report is provided as Attachment 1 and the Spanish version is provided as Attachment 2. Additionally, the Oversight Committee has submitted a Committee Review letter (Attachment 3) outlining their approval and recommendations for the Board to review.
The Annual Report is also a tool for communicating to the public the impact of these Measure O funds in providing essential services to the community. The Measure O Annual Report will be posted on the County’s website and emailed to the list of stakeholders and public who have joined the Measure O mailing list. Hard copies in English and Spanish are available through DHS.
Behavioral Health School Partnership - Initial Implementation - Near Term
Of 38,000 Sonoma County respondents to the January 2022 YouthTruth student survey, 48 percent of middle school students and 55 percent of high school students cite feeling depressed, stressed, or anxious. These feelings are the most-identified obstacle to learning.
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 is 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 on October 11, 2022. The program includes a multi-phase implementation approach over the next three years. This item includes a request to add staff for the initial implementation of the program.
Staff needed for the initial phase of the program include an Alcohol and Other Drug Services (AODS) Counselor II, a Behavioral Health Clinician, a Health Program Manager, and a Senior Office Assistant (all 1.00 FTE). The AODS Counselor II will facilitate the provision of substance use disorder services (SUDS) to students, either through direct services or referral to DHS Behavioral Health or elsewhere in the community. The Behavioral Health Clinician will facilitate the provision of mental health services to students who may be experiencing a mental health crisis, or who need assistance in accessing mental health services through DHS Behavioral Health or elsewhere in the community. The Health Program Manager will provide program implementation support along with on-going supervision and program management to ensure successful delivery of services. The Senior Office Assistant will support program staff and assist in providing effective and efficient access to services. The cost for each position is provided in the table below. It is anticipated that Measure O will be the ongoing funding source for these positions.
|
Position |
FY 22-23 |
FY 23-24 |
FY 24-25 |
FY 25-26 |
|
Alcohol and Other Drug Services Counselor II |
$52,803 |
$203,891 |
$214,086 |
$224,790 |
|
Behavioral Health Clinician |
$60,062 |
$231,921 |
$243,517 |
$255,693 |
|
Health Program Manager |
$66,033 |
$254,977 |
$267,726 |
$281,112 |
|
Senior Office Assistant |
$41,454 |
$160,071 |
$168,075 |
$176,478 |
|
Total |
$220,352 |
$850,861 |
$893,404 |
$938,074 |
In Fiscal Year 2022-23, there are additional service and supply costs of $30,150 to establish the program.
Behavioral Health School Partnership - Multi-Phase Implementation - Long Term
This new program will provide 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
• Four 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
This program will utilize Measure O funding and leverage funding from Mental Health School Services Act Grant (MHSSA), Medi-Cal Administrative Activities (MAA), Organized Delivery System (ODS) Waiver, and Mental Health Services Act (MHSA).
Proposed full staffing plan in Phase 4 beginning in FY25-26:
• Health Program Manager x 1
• Behavioral Health Clinical Specialist x 1 (funded by MHSSA)
• Behavioral Health Clinician/Intern x 4
• Certified AODS Counselor II x 4
• Senior Office Assistant x 1
• Regional Peer Providers via RFP ($600,000 over 3 years)
These clinical staff should be able to code 50 to 60 percent of their time to Medi-Cal Administrative Activities (MAA), which will generate revenue to offset the cost of the positions. The Peer Provider RFP will utilize Mental Health Services Act (MHSA) funding.
|
Estimated Expenditures |
FY 23-24 |
FY 24-25 |
FY 25-26 |
|
Phase 1 - Core Team Hired |
1,100,408 |
1,155,429 |
1,213,200 |
|
Phase 2 - Expand to 2 Teams |
|
457,603 |
480,483 |
|
Phase 3 - 3 Teams (partial year) |
|
228,801 |
480,483 |
|
Phase 4 - 4 Teams (partial year) |
|
|
360,362 |
|
Operating Costs |
100,500 |
263,812 |
443,205 |
|
Peer Contracts |
200,000 |
200,000 |
200,000 |
|
Total Program Costs |
1,400,908 |
2,305,646 |
3,177,734 |
|
|
|
|
|
|
Estimated Funding |
FY 23-24 |
FY 24-25 |
FY 25-26 |
|
Mental Health Student Services Act |
231,063 |
240,972 |
250,611 |
|
Mental Health Medi-Cal Administrative Activities |
|
375,000 |
562,500 |
|
Medi-Cal Organized Delivery System |
|
133,803 |
280,987 |
|
MHSA Community Services and Support |
200,000 |
200,000 |
200,000 |
|
Measure O |
969,846 |
1,355,871 |
1,883,636 |
|
Total Funding |
1,400,909 |
2,305,646 |
3,177,734 |
The Department plans to utilize up to $4.2 million over three years from Measure O category 2a beginning with $969,846 in fiscal year 2023-2024 to create the Measure O Behavioral Health School Partnership with the Sonoma County Office of Education to provide behavioral health services. The Department will return to the Board in December 2023 to update on the board on hiring plans for the remainder of the staffing needed.
Complimentary Youth Substance Use Disorder (SUD) Treatment Expansion RFP Background
The 2021 SUD Mapping Project reviewed the entire SUD Continuum of Care and found that Youth SUD Treatment is the most significant gap in SUD services in the County. The Department is notifying the Board of the intent to administer an RFP for these services, that will serve as complimentary services to the Behavioral Health School Partnership. The Department intends to bring selected contracts forward for Board approval in December 2023.
The proposed Youth Treatment RFP will utilize up to $2.4 million of Measure O funding to bring additional youth SUD treatment providers online in Sonoma County. The only current local provider of adolescent outpatient treatment has limited outreach capacity and provides early intervention services in only a few high schools.
Program Details:
Eligible applicants:
• adolescent youth residential treatment providers for ages (12 to 17) and/or
• youth/young adult outpatient SUD treatment for ages (12 to 25) including family therapy and/or
• youth/young adult intensive outpatient SUD treatment for ages (12 to 25) including family therapy and/or
• co-occurring therapy for youth/young adults for ages (12 to 25) including family therapy
Priority Service Areas: West County, Rohnert Park and Petaluma (higher rates of overdose) and providers capable of services countywide.
Priority Populations:
• Latinx including services for monolingual Spanish (could potentially utilize Community Health Workers to conduct SUD prevention and education on school campuses)
• LGBTQ+ youth and young adults
Contracted providers will connect with County AOD Counseling staff and provide complimentary SUD treatment programs to support students and their families.
The RFP will serve as seed funding for selected contracted providers to apply for Drug Medi-Cal (DMC) certification, allowing for additional draw-down to offset costs and increasing DMC providers countywide.
Budget Appropriations for FY 22-23
This item includes a request for approval of a resolution authorizing budgetary adjustments of $250,502 to the fiscal year 2022-2023 adopted budget, programming Measure O fund balance for the fiscal year 2022-2023 costs.
References:
Expenditure Plan Measure O - <https://sonomacounty.ca.gov/health-and-human-services/health-services/divisions/behavioral-health/about-us/measure-o/expenditure-plan>
Strategic Plan:
N/A
Prior Board Actions:
On May 24, 2022 the Board received the Measure O Annual Report for Fiscal Year 2020-2021 as approved by the Citizen’s Oversight Committee for Measure O.
On December 7, 2021 the Board adopted a resolution creating the Measure O Citizens’ Oversight Committee, appointed seven members to the Measure O Citizens’ Oversight Committee, and adopted bylaws to govern the responsibilities of the Citizens Oversight Committee.
On August 4, 2020 the Board A) adopted an Ordinance entitled the “Sonoma County Local Mental Health, Addiction and Homeless Services Measure Transaction and Use Tax Ordinance” imposing a countywide quarter-cent special transactions and use tax (sales tax) in Sonoma County for Sonoma County behavioral health and homeless services pursuant to Revenue and Taxation Code section 7285.5; B) authorized the Department of Health Services to coordinate with the County Administrator to contract with the California Department of Tax and Fee Administration to administer the tax, if approved by voters; and C) adopted a resolution calling a special election to submit to the voters of Sonoma County a one-quarter of one percent (0.25%) sales tax measure entitled “the Sonoma County Local Mental Health, Addiction and Homeless Services Measure Transaction and Use Tax Ordinance” and ordering that the special election be consolidated with the statewide general election to be conducted on November 3, 2020.
Fiscal Summary
|
Expenditures |
FY 22-23 Adopted |
FY 23-24 Projected |
FY 24-25 Projected |
|
Budgeted Expenses |
|
1,400,909 |
2,305,646 |
|
Additional Appropriation Requested |
250,502 |
|
|
|
Total Expenditures |
250,502 |
1,400,909 |
2,305,646 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
250,502 |
1,400,909 |
2,305,646 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
250,502 |
1,400,909 |
2,305,646 |
Narrative Explanation of Fiscal Impacts:
The Department is requesting $250,502 in appropriations for FY 22-23 to cover staff costs, services and supplies ($220,352 in salaries in $30,150 in supplies), and overhead costs for 7.3 pay periods (approximately 28% of the year). Funding for FY 22-23 will be from the Mental Health Student Services Act and Measure O funding (Category 2A). The Department will include FY 23-24 with the supplemental budget process, funding will be from the Mental Health Student Services Act, Mental Health Services Act Community Support Services (Peer Contracts), and Measure O (Category 2A). Future year expenditures will be included via the annual budgetary process. Request for $800,000 over 3 years for RFP will begin in FY 23-24; appropriations will be requested via Supplemental budget process.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
Alcohol and Other Drug Services Counselor II |
$5,766-$7,009 |
1.00 |
0.0 |
|
Behavioral Health Clinician |
$6,792-$8,255 |
1.00 |
0.0 |
|
Health Program Manager |
$7,693-$9,350 |
1.00 |
0.0 |
|
Senior Office Assistant |
$3,917-$4,760 |
1.00 |
0.0 |
Narrative Explanation of Staffing Impacts (If Required):
These added positions will take on the duties of a new program. The addition of these positions will enable us to reach and provide services to youth in school settings and improve their abilities to access needed services and support. There will be no impact on existing positions.
Attachments:
Attachment 1 - Annual Report for Fiscal Year 2021-2022 (English)
Attachment 2 - Measure O Informe Annual 2021-2022 (Spanish)
Attachment 3 - Committee Review Letter
Attachment 4 - Personnel Resolution
Attachment 5 - Budget Resolution
Related Items “On File” with the Clerk of the Board:
None