To: Board of Supervisors of Sonoma County
Department or Agency Name(s): Department of Health Services, Human Services Department, Community Development Commission, Probation Department, District Attorney, and Public Defender
Staff Name and Phone Number: Barbie Robinson, 565-7876, Karen Fies, Margaret Van Vliet, David Koch, Jill Ravitch, and Kathleen Pozzi
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Homeless Mentally Ill Outreach and Treatment Program
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Recommended Actions:
recommended action
Approve Homeless Mentally Ill Outreach and Treatment Program funded projects as outlined in this report.
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Executive Summary:
As part of the one-time appropriations authorized by the California legislature to address homelessness, the California Department of Health Care Services recently released funding allocations for Homeless Mentally Ill Outreach and Treatment Program funding authorized as part of the state’s 2018-2019 Budget Act. The Homeless Mentally Ill Outreach and Treatment Program is designed to provide flexible one-time funding for county activities involving individuals with serious mental illness and who are homeless or at risk of homelessness.
At the September 18, 2018 Board meeting, the Board approved a resolution authorizing participation in the Homeless Mentally Ill Outreach and Treatment Program. At that time, the sponsoring departments stated that they would return to the Board with programmatic details regarding proposed projects to be implemented utilizing Homeless Mentally Ill Outreach and Treatment Program funding. This item provides proposed project and cost information and requests approval to implement these projects.
Discussion:
The California Department of Health Care Services recently released funding allocations for one-time Homeless and Mentally Ill Outreach and Treatment Program funding authorized as part of Senate Bill 840, the state’s 2018-2019 Budget Act. The Homeless Mentally Ill Outreach and Treatment Program is designed to provide flexible one-time funding for county activities involving individuals with serious mental illness and who are homeless or at risk of homelessness. All California counties are eligible to receive this funding, and counties are encouraged to leverage this funding with other funding sources and initiatives, including Whole Person Care pilots and efforts to address mental illness among populations with a high likelihood of homelessness, including those with recent involvement in the criminal justice system or release from incarceration. The one-time Homeless and Mentally Ill Outreach and Treatment Program funding allocation for Sonoma County is $1,314,000.
Counties receiving Homeless Mentally Ill Outreach and Treatment Program funding may use this funding to leverage other funding sources, such as federal grants, in serving individuals with severe mental illness who are also homeless or at immediate risk of being homeless. Funds may be used to pay for only that portion of the costs of services not otherwise provided by federal funds or other state funds and shall not supplant other funds for these purposes.
The Safety Net Departments have assessed several projects that align with Homeless Mentally Ill Outreach and Treatment Program guidelines and are well-suited to serve the target population. Given that Program funding is for one-time expenditures and must be utilized by June 30, 2020, only projects that will not result in long-term fiscal impacts will be implemented. Projects planned by the Safety Net Departments are described below.
Housing Expansion for the Mentally Ill (Probation) ($215,000)
Probation currently operates 65 transitional housing beds for homeless offenders, distributed among six houses located in Santa Rosa, Rohnert Park, and Glen Ellen. Housing services include case management; individual therapy; individual and group counseling; skill-building; referrals for substance abuse, healthcare, food, and general assistance services; employment preparation; and permanent housing search and placement assistance.
While many transitional housing residents have mild to moderate levels of mental illness, the current infrastructure is not equipped to accommodate justice system-involved individuals with serious mental illness. To address this gap, the Probation Department, the Sheriff’s Office, and the Department of Health Services submitted a grant application to the U.S. Bureau of Justice Assistance in May 2018, which was successful and accepted by the Board on December 11, 2018. The grant will provide $750,000 over three years to address individuals in the criminal justice system who have mental health and substance use disorders. In part, funding will support operating costs of an eight-bed transitional housing facility for individuals on pretrial release with mental illness or co-occurring mental illness and substance abuse disorder. The location of the house, expected to open by September 2019, has not yet been identified, and will be subject to a competitive procurement process. Funding will cover a property lease, housing provider staff, and case management staff but will not be sufficient to cover start-up costs or anticipated additional needs for mental healthcare staff.
The Homeless Mentally Ill Outreach and Treatment Program funding considered in this report will support these program costs as follows: 1) start-up costs: $50,000 for building modifications, appliances, and initial supplies and 2) mental health and substance abuse treatment staff: $165,000 for the first year of contracted mental health counselors. The goals of this housing initiative are to reduce unnecessary incarceration, provide treatment and services to improve outcomes of justice system-involved individuals, and increase public safety.
Sequential Intercept Model Mapping Report Priority Recommendations (a component of the Stepping Up Initiative) (Probation) ($117,000)
Separate from the grant above, the U.S. Bureau of Justice Assistance awarded Sonoma County an additional $750,000 grant, which will fund contracted peer navigators and case managers. These peer navigators and case managers will support newly released individuals who have co-occurring mental health and substance abuse disorders; facilitate connections with support services, such as peer groups at Interlink Self-Help Center and cognitive behavioral classes; and provide case management services for pre- and post-adjudicated persons diagnosed as mentally ill.
A continuing challenge not addressed by this funding is safely transitioning individuals from detention to initial treatment services. Specifically, the following two service gaps exist: 1) lack of transportation from jail to community services for homeless persons with mental illness and 2) a safe place to stay when these individuals are released from the jail outside of normal business hours to bridge the time until they can be connected with transitional housing or other shelter options and treatment services.
The Probation Department intends to use Homeless Mentally Ill Outreach and Treatment Program funding to address these challenges by funding the following: 1) A pilot project with a contracted local paratransit company to transport members of this target group to the Crisis Stabilization Unit, transitional housing, or a local shelter in the amount of $25,000 for one year, and 2) Purchase of a large trailer and furnishings to be set up as a “re-entry center” at a location near the Main Adult Detention Facility for $92,000. Before proceeding with this project, Probation, the Sheriff’s Office, and Behavioral Health will need to develop strategies for staffing and maintenance.
Expanded Functionality of the ACCESS Sonoma Data Hub Project (Health Services, et al.) ($518,000)
On December 5, 2017, the Board of Supervisors adopted a resolution approving the development of an integrated data hub to support integrated case management by the Interdepartmental Multi Discipline Team. Designed by IBM with input from the Interdepartmental Multi-Disciplinary Team, this integrated case management system facilitates client care for a variety of cohorts consisting of clients with complex, interrelated needs in the areas of homelessness, mental health, substance abuse, food and economic insecurity, and interaction with law enforcement. Since July 9, 2018, the Interdepartmental Multi-Disciplinary Team has used this system to support case management of the victims of the October 2017 fires who remained homeless weeks after the fires were extinguished. In addition to assisting the fire victims, the team is currently using the system to support case management of homeless residents who have complex mental health, substance abuse, and/or physical health issues contributing to their homelessness. The ongoing design and use of the system is consistent with the Homeless and Mentally Ill Outreach and Treatment Program objectives. To date, the system has been used primarily to case manage clients who are homeless or at risk of homelessness and have additional high needs such as mental health, substance abuse, physical health, or other factors contributing to a lack of self-sufficiency.
The integrated case management system is being developed in multiple phases. Phase 1 and Phase 2 of the project have been completed, with both phases delivering functionality to support care management by the Interdepartmental Multi-Disciplinary Team. Phase 3 of the project was approved by the Board of Supervisors on December 11, 2018 and will add functionality including additional data from Safety Net Departments, basic referral capability, basic alert capability, mobile capability, and electronic authorization.
Phase 4 of the project is scheduled to begin in Fall 2019 and will continue to enhance system capabilities in support of high need homeless clients, Whole Person Care initiatives, and other related cohorts. The Safety Net Departments intend to use $518,000 of the allocated Homeless Mentally Ill Outreach and Treatment Program funding to support Phase 4 system development which will include:
1) Additional data from Safety Net Department systems, which provides insights and information that the care teams can use to assist clients in achieving goals.
2) Enhanced referral capability that will engage community partners in client care.
3) Enhanced alert capabilities that notify care team members of important issues and events. These alerts will allow care team members to help clients stay on track towards achieving goals.
4) Client portal enhancements that allows the client to track progress towards achieving their goals.
5) Expanded security roles to support community partner access.
6) Basic community partner access to information, which will allow community clinics and other partners to participate in a client’s care management, access critical data for care coordination, and provide far greater care coverage than the County’s internal care team can provide.
Management and Supervision of ACCESS Sonoma Interdepartmental Multi-Disciplinary Team (Health Services, et al.) ($214,000)
As described above, in December 2017 the Board of Supervisors approved multiple safety net initiatives including the establishment of the ACCESS Sonoma initiative and the Interdepartmental Multi-Disciplinary Team whose focus is to identify and coordinate services for vulnerable, high-risk individuals that access services delivered by the participating Safety Net Departments. Over the past year, the Interdepartmental Multi-Disciplinary Team has provided homeless and at-risk individuals who have high-level mental health, substance abuse, and physical health issues with assessment, care management and service referral. During this development and growth phase, the team has managed one cohort at a time and a dedicated supervisor/manager has not been assigned to oversee the Interdepartmental Multi-Disciplinary Team. With the extension of the Whole Person Care pilot and the simultaneous addition of other high-needs cohorts to be care managed by the Interdepartmental Multi-Disciplinary Team, a dedicated manager/supervisor will be needed to effectively provide direction, oversight, and management support to the team. Homeless and Mentally Ill Outreach and Treatment Program funding of $214,000 will cover salary, benefits, and associated costs of one full-time equivalent time-limited Health Program Manager for one year while multiple cohorts are being served by the Interdepartmental Multi-Disciplinary Team.
Mapping Housing Inventory (CDC) ($50,000)
This project serves to provide a better understanding of the various housing programs across each of the Departments and the populations they target in order to better utilize programs and resources for the mentally ill homeless population. The Community Development Commission will work with subject matter experts to develop a report that maps existing housing inventory (permanent supportive housing, shelter, transitional housing, and rapid re-housing) identified in the U.S. Department of Housing and Urban Development Housing Inventory Chart. This report will also identify gaps in housing inventory for individuals with mental illness and will be linked with a revised 10 Year Homeless Action Plan that will be developed in 2019. Approximate cost of this project is $50,000 for consultant services.
Rental Assistance (CDC) ($200,000)
Individuals in the mentally ill homeless population often need rental assistance, especially in light of the high costs of living. This component supports our housing first model and can be seeds for No Place Like Home efforts. Individuals with serious mental illness often need short-term rental assistance as a bridge to permanent housing and permanent supportive housing. The Community Development Commission plans to utilize $200,000 of Homeless Mentally Ill Outreach and Treatment Program funding for a pilot project to provide short term rental assistance for individuals with serious mental illness in the form of move-in deposits and eviction prevention. Individuals in Coordinated Entry will be linked with the Health Services Behavioral Health Division for screening, assessment, and referral for short-term rental assistance.
Summary of Proposed Program Funding - A summary of proposed programs to be funded with Homeless Mentally Ill Outreach and Treatment Program funding is provided as Attachment 1.
The Safety Net Departments will seek Board approval, as necessary, to execute contracts and adjust staffing to support the projects contemplated in this report.
Prior Board Actions:
On December 11, 2018 the Board approved Addendum 2 to the Statement of Work with International Business Machines Corporation for implementation of Phase 3 of the ACCESS Sonoma Data Hub Project, increasing the contract amount by $1,800,000 resulting in a new total not-to-exceed amount of $4,797,000, and any amendments that do not substantially change the scope of work or increase funding.
On December 11, 2018 the Board 1) accepted $750,000 revenue from the Bureau of Justice Assistance’s “Justice and Mental Health Collaboration Program” for services through December 31, 2021 and 2) accept $750,000 revenue from the Bureau of Justice Assistance’s “Improving Reentry for Adults with Co-occurring Substance Abuse and Mental Illness” program for services through December 31, 2021.
On September 18, 2018 the Board adopted a resolution authorizing participation in the one-time Homeless Mentally Ill Outreach and Treatment Program funding opportunity available as a result of Senate Bill 840.
On December 5, 2017 the Board approved a “Securing the Safety Net Update” item, which included the following actions:
A) Receive a report on the activities underway to address the Board of Supervisors priority to Secure the Safety Net. The report includes updates on (1) how safety net departments are utilizing the Board’s strategic priority initiatives to deploy a rapid response to address the service needs of victims of the Sonoma Complex Fires; (2) the ACCESS Sonoma County project (formerly called Project 301); and (3) the planned implementation of the Whole Person Care Pilot and Drug Medi-Cal Programs.
B) Adopt a resolution approving the county Safety Net Departments and Community Develop Commission to strengthen coordinated, client-centered care delivery strategies and develop an information hub to facilitate successful implementation of disaster rapid response efforts, ACCESS Sonoma County, and Whole Person Care projects.
Fiscal Summary
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Expenditures |
FY 18-19 Adopted |
FY19-20 Projected |
FY 20-21 Projected |
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Budgeted Expenses |
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Additional Appropriation Requested |
1,314,000 |
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Total Expenditures |
1,314,000 |
0 |
0 |
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Funding Sources |
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General Fund/WA GF |
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State/Federal |
1,314,000 |
0 |
0 |
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Fees/Other |
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Use of Fund Balance |
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Contingencies |
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Total Sources |
1,314,000 |
0 |
0 |
Narrative Explanation of Fiscal Impacts:
Fiscal year 2018-2019 appropriations for expenditures related to the projects outlined in this item will be added to the fiscal year 2018-2019 budget via third quarter consolidated budget adjustments. Funding to be rolled over to fiscal year 2019-2020 will be included in the fiscal year 2019-2020 budget. Homeless Mentally Ill Outreach and Treatment Program funding must be spent by June 30, 2020. No local match is required for the Homeless Mentally Ill Outreach and Treatment Program funding allocation.
Staff will return with future a Board item(s) to obtain approval of a budget resolution and any associated contracts or staffing adjustments as necessary.
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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:
Summary of Proposed Program Funding
Related Items “On File” with the Clerk of the Board:
None