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: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Department of Health Services Budget Appropriation
End
Recommended Action:
Recommended action
A) Authorize the Director of Health Services, or designee, to execute amendments to agreements with the cities of Rohnert Park, Cotati, Petaluma, and Santa Rosa, to provide an additional $500,000 of funding to support mobile crisis services. The total amended agreements result in a cost not to exceed $2,679,668 for the period September 15, 2021, through June 30, 2025.
B) Adopt a Resolution authorizing budgetary adjustments to the Fiscal Year 2024-2025 adopted budget, increasing appropriations in the amount of $500,000 to reflect revenue and expenditures supporting behavioral health mobile crisis services through June 30, 2025. (4/5th Vote Required)
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Executive Summary:
On August 23, 2021, the Sonoma County Department of Health Services (“DHS” or “the Department”) applied to the California Department of Health Care Services (DHCS) for Crisis Care Mobile Units Program funding. On November 10, 2021, DHS was awarded $2,498,899 for the term of September 15, 2021, through June 30, 2025.
On February 6, 2024, DHCS offered an opportunity to apply for additional funding of $500,000 to be used to support direct services with local city partners, Santa Rosa, Petaluma, Rohnert Park, and Cotati. DHS applied for and on June 24, 2024 was awarded the additional funds.
This item requests approval to execute amendments to agreements with the cities of Rohnert Park, Cotati, Petaluma, and Santa Rosa and of a budget adjustment to the Fiscal Year 2024-2025 adopted budget in the amount of $500,000, to increase revenue and expenditures appropriations to support the agreements.
Discussion:
The Department of Health Services has operated the Mobile Support Team (MST) program since 2012. The MST responds to law enforcement requests for support on calls in which individuals may be experiencing a behavioral health crisis. The MST program has expanded or retracted as funding has fluctuated. It is the intention of Sonoma County to eventually serve all geographic regions with 24/7 mobile crisis services.
In August 2021, DHS partnered with the cities of Santa Rosa, Petaluma, Rohnert Park, and Cotati, to apply for the California Department of Health Care Services (DHCS) Crisis Care Mobile Units (CCMU) Program. In November 2021, DHS received grant approval for funding in the amount of $2,498,899. The CCMU award requires a minimum of 75% of the funds be committed to infrastructure costs and a maximum of 25% set aside for services to individuals who do not have insurance coverage or are underinsured. All CCMU grantees are required to prioritize mobile behavioral health crisis services for individuals aged 25 and younger, while also serving the broader population, and are encouraged to support justice intervention services.
The Crisis Care Mobile Units (CCMU) Program utilizes funding received from the Behavioral Health Continuum Infrastructure Program and the Substance Abuse and Mental Health Services Administration (SAMHSA) through the Coronavirus Response and Relief Supplemental Appropriations Act (CRRSAA). The Department provided funding to partner jurisdictions to finance infrastructure costs that support implementation of mobile crisis services programs. Rohnert Park and Cotati are to receive a total of $916,630 to support establishment of their joint program. Due to an established Memorandum of Understanding, this award was split between the two cities at 86% Rohnert Park and 16% Cotati: $769,969 to Rohnert Park and $146,661 to Cotati. The City of Petaluma Specialized Assistance for Everyone (SAFE) program received $916,629 to expand services. Finally, the City of Santa Rosa received $415,529 for support of the inRESPONSE program. These funding agreements are providing funding in addition to the $941,887 Measure O funded agreements approved by the Board on October 26, 2021.
In March 2023, DHS was notified of a $69,120 decrease in funding thus reducing the overall budget which still allowed $250,112 to be used by DHS to administer and manage the grant and establish a collaborative program outcome and evaluation workgroup, all of which must be led by staff in the DHS Health Policy, Planning and Evaluation (HPPE) Unit through the end of the grant on June 30, 2025.
DHS continues to work with city partners and the Mobile Support Team staff to understand and evaluate the program models of mobile crisis support being offered amongst the city and County teams.
Cities Developing Mobile Crisis Services
In response to community interest, several cities within Sonoma County committed to establishing mobile crisis services, developing models consistent with the Eugene, Oregon, White Bird Clinic CAHOOTS program. The most significant innovation of the CAHOOTS model is that behavioral health and emergency medical service teams act as first responders to service calls that do not require law enforcement resources.
The development of programs in Santa Rosa, Petaluma, Rohnert Park, and Cotati creates additional opportunities for the Board of Supervisors’ investment of Measure O funds, as well as continued collaborations to further city/county efforts.
The Petaluma Specialized Access for Everyone (SAFE) program operated by Petaluma People Services Center (PPSC) began providing mobile support services in Petaluma in July 2021.
The Santa Rosa Police Department established the inRESPONSE program, a partnership with Santa Rosa Fire Department, the Department of Health Services, Buckelew Programs, and Catholic Charities, which launched in January 2022.
The cities of Rohnert Park and Cotati worked with a crisis consultant to assist with implementation of their response unit. In addition to Petaluma, Rohnert Park and Cotati, entered into agreements with Petaluma People Services Center to operate their mobile support team programs. The Rohnert Park/Cotati SAFE Team started training on October 18, 2021, and launched operations in November 2021.
In February of 2024, Advocates for Human Potential, Inc. (AHP), as DHCS’s third party administrator for the CCMU Program, announced there would be an additional funding opportunity for direct service expenditures. DHS applied for and was awarded the maximum amount of $500,000. These funds are to be split between the teams of SAFE Rohnert Park ($146,667 for a new not to exceed amount of $916,635) and Cotati ($19,999 for a new not to exceed amount of $166,660), SAFE Petaluma ($166,667 for a new not to exceed amount of $1,083,296), and the City of Santa Rosa’s ($166,667 for a new not to exceed amount of $513,076) inRESPONSE programs.
These funds may be used by the cities to cover direct service costs such as the salaries for staff on the mobile service vehicles providing direct support to the community. They may not be used to support the purchase of infrastructure such as vehicles and cannot be recategorized. Any remaining unused funds will be forfeited when the grant ends June 2025.
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: Create a “no wrong door” approach where clients who need services across multiple departments and programs are able to access the array of services needed regardless of where they enter the system.
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
September 20, 2022: The Board authorized the Director of Health Services, or designee to execute a revenue agreement with Advocates for Human Potential, Inc. (state contractor) to accept revenue in the amount of $2,498,899 to support local mobile support team programs and to execute agreements with the cities of Santa Rosa, Rohnert Park, Cotati, and Petaluma. In the amount of $2,248,787 with $250,112 to support the department grant administration and management.
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 both Cotati/Rohnert Park and Petaluma, 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 for Calendar Year 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
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Expenditures |
FY 24-25 Adopted |
FY 25-26 Projected |
FY 26-27 Projected |
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Budgeted Expenses |
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Additional Appropriation Requested |
$500,000 |
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Total Expenditures |
$500,000 |
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Funding Sources |
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General Fund/WA GF |
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State/Federal |
$500,000 |
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Fees/Other |
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Use of Fund Balance |
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General Fund Contingencies |
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Total Sources |
$500,000 |
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Narrative Explanation of Fiscal Impacts:
This request will increase FY 2024-2025 revenue and expenditure appropriations in the amount of $500,000. This funding award was not included in the annual recommended fiscal year 2024-2025 budget as guarantee of funding was not received until June 24, 2024.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - Budget Resolution
Attachment 2 - CCMU Funding Summary
Attachment 3 - Advocates for Human Potential Funding Agreement
Attachment 4 - DRAFT City of Cotati Agreement
Attachment 5 - DRAFT City of Petaluma Agreement
Attachment 6 - DRAFT City of Rohnert Park Agreement
Attachment 7 - DRAFT City of Santa Rosa Agreement
Related Items “On File” with the Clerk of the Board:
None