To: Board of Supervisors of Sonoma County
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Barbie Robinson, 565-7876
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Department of Health Services Behavioral Health Staffing Allocations
End
Recommended Action:
Recommended action
A) Adopt a personnel resolution effective September 10, 2019 adding 13.70 full-time equivalent positions as detailed in the attached resolution within the Department of Health Services.
B) Authorize the Department of Health Services to adjust their fiscal year 2019-2020 budget through the first quarter consolidated budget adjustments process.
end
Executive Summary:
During the fiscal year 2019-2020 budget process, the Department proposed a redesign of Behavioral Health Adult Services programming to balance the fiscal year 2019-2020 budget. The proposed redesign represented an expansion of programs and services funded by Mental Health Services Act and Medi-Cal Federal Financial Participation revenues but a reduction in realignment funded services. The Department’s redesign of the system, known as the Adult Full-Services Partnership, prioritizes services for those with the most acute needs, but many other clients with lower-level needs previously served by the Behavioral Health system of care would no longer be served without further intervention by the Board.
During the budget hearings, the Board authorized $900,000 in discretionary funding (Graton Mitigation and Reinvestment & Revitalization) that enabled the Department to backfill realignment funded services and contracts in addition to the acute level services that will be offered by the Adult Full-Service Partnership programming. This staff report implements the steps necessary to utilize the funding provided by the Board for restorations, and as directed by the Board, the steps necessary to continue the Adult Full-Service Partnership and Hospital Liaison programs through the addition of 9.30 Full-Time Equivalent (FTE) allocations.
In addition, the Department is requesting 4.40 FTE, including 3.40 time-limited staff allocations to support efforts related to one-time new funding received after the budget process was completed. The funding includes a grant from the California Department of State Hospitals, an agreement with the Probation Department to provide juvenile sex offender services, and grant funding from the Whole Person Care Program and the Homeless Mentally Ill Outreach and Treatment Program.
Discussion:
The Department of Health Services is requesting approval of an additional 13.70 FTE allocations in its Behavioral Health Division as follows:
1) 8.30 FTE allocations in the Adult Full-Service Partnership program as a result of the Board’s decision to restore $900,000 in funding during the fiscal year 2019-2020 budget hearings;
2) 1.00 FTE Behavioral Health Clinician in the Hospital Liaison Program;
3) 1.00 time-limited Health Program Manager to lead the Interdepartmental Multi-Disciplinary Team within the ACCESS program;
4) 1.00 full-time equivalent Behavioral Health Clinician Intern to provide clinical services as a part of the Probation Department’s juvenile sex offender program; and
5) 2.40 time-limited allocations for a California Department of State Hospitals funded diversion program for individuals deemed incompetent to stand trial due to a mental illness.
Board Restoration of Adult Services Team Funding
As identified in the Department of Health Services’ June 11, 2019 Budget Memo to the Board of Supervisors, the Department’s fiscal year 2019-2020 was facing an $11 million revenue gap including $8 million in its Behavioral Health Division and $3 million in its Public Health Division. Factors contributing to the revenue gap included flat growth in a major funding stream, 1991 Realignment; increasing costs (i.e., labor, residential care facility contracts); and decreasing revenue (e.g., Medi-Cal, Mendocino Laboratory services contract).
To address the fiscal year 2019-2020 revenue gap, the Department’s fiscal year 2019-2020 Recommended Budget proposed a series of program and services reductions in its Behavioral Health and Public Health Divisions including the reduction of 13.60 full-time equivalent positions in the Behavioral Health Adult Services Team for a savings of approximately $1.7 million. The Adult Services Team program provides specialty mental health services to clients with severe mental illness including assessment, case management, care planning, therapy, and linkages to other services for individuals not currently in need of more intensive Full-Service Partnership services.
Under the Department’s fiscal year 2019-2020 Recommended Budget, the reduction of the 13.60 full-time equivalent positions would not have resulted in layoffs because it was the Department’s plan to move those staff into other Mental Health Services Act funded programs including the Adult Full-Service Partnership program.
During the fiscal year 2019-2020 budget hearing process the Board approved a total of $6.8 million in restoration funding including $6.01 million for Behavioral Health and $823,000 for Public Health. Attachment 2 provides a summary of the restoration funding approved by the Board.
As noted the attached table, during the budget hearing process the Board approved $900,000 in ongoing Graton Mitigation and Reinvestment & Revitalization funding to restore the Behavioral Health Adult Services Team. With the restoration, the Department will be able to draw down an additional $300,000 in Federal Financial Participation for total program funding of $1.2 million. With this funding the Department was able to restore 8.30 of the 13.60 full-time equivalent positions within the Department’s Adult Services Team.
Allocation Request for MHSA Funded Full-Service Partnership Program
With the restoration of the Adult Services Team funding, the Department determined it was best for the Adult Services Team staff to continue serving in their existing capacities rather than transfer them to the Adult Full-Services Partnership program as originally recommended by Department staff as a budget balancing strategy. As a result, the Department’s fiscal year 2019-2020 adopted budget has appropriations for the redesigned and expanded Mental Health Services Act programs, without the requisite staffing allocations needed to fill the needed positions. As such, the Department is requesting the following 8.30 full-time equivalent allocations:
• Adult Full-Service Partnership
- Program Description: Provides intensive in-home mental health services assisting clients to accomplish goals that are important to the health, well-being, safety, and stability of the family. Services may include individual and family counseling, 24/7 assessment and crisis services, and in-home supportive services, all of which are delivered via a “wraparound” service model.
- Requested Staffing Allocations: 5.50 full-time equivalent allocations including 1.00 full-time equivalent Behavioral Health Clinician Intern; 1.00 Health Program Manager; 3.00 full-time equivalent Senior Client Support Specialists; and 0.50 full-time equivalent Senior Office Assistant
- Annual Cost: $751,104
- Funding: Mental Health Services Act included in fiscal year 2019-2020 budget.
• Adult Access
- Program Description: Screens and assesses adult clients upon entry into the Mental Health Plan to assess eligibility and ensure placement at the appropriate level of care.
- Requested Staffing Allocations: 1.00 full-time equivalent Senior Office Assistant
- Annual Cost: $97,875
- Funding: Mental Health Services Act funding included in fiscal year 2019-2020 budget.
• Youth Access
- Program Description: Screens and assesses youth clients upon entry into the Mental Health Plan to assess eligibility and ensure placement at the appropriate level of care.
- Requested Staffing Allocation: 1.0 full-time equivalent Senior Office Assistant
- Annual Cost: $97,875
- Funding: Mental Health Services Act funding included in fiscal year 2019-2020 budget.
• Community Mental Health Clinics
- Program Description: Provides access for underserved populations, including mental health outpatient therapy and case management services to locally underserved racially and ethnically diverse communities, and homeless individuals with mental illness, in four regionally-based areas of Sonoma County: Guerneville, Cloverdale, Petaluma, and Sonoma.
- Requested Staffing Allocation: 0.50 full-time equivalent Senior Office Assistant
- Annual Cost: $48,937
- Funding: Mental Health Services Act funding included in fiscal year 2019-2020 budget.
• Whole Person Care
- Program Description: Provides outreach and engagement services and intensive case management services with the goal of identifying clients, building trust, and completing comprehensive assessments to identify medical, behavioral health, social service, and the housing needs of the client.
- Requested Staffing Allocation: 0.30 full-time equivalent Senior Office Assistant
- Annual Cost: $29,363
- Funding: Mental Health Services Act funding included in fiscal year 2019-2020 budget.
Allocation Request for Hospital Liaison Program
In addition to the above 8.30 full-time equivalent allocations funded with Mental Health Services Act revenue, the Department is requesting a 1.00 full-time equivalent Behavioral Health Clinician Intern in the Hospital Liaison Program. The position will provide concurrent utilization review services to evaluate medical necessity, appropriateness, and efficiency of services provided to Medi-Cal beneficiaries in an inpatient setting. Provision of concurrent review services was recently mandated by the state via the California Department of Health Services May 31, 2019 Information Notice 19-026 which states “Effective immediately, [Mental Health Plans] are required to conduct concurrent review and authorization for all psychiatric inpatient hospital services and psychiatric health facility services.”
In addition to being mandated by the state, the position will play a key role in the Department’s redesigned continuum of care working to ensure beneficiaries are receiving services at the appropriate level of care. The position has an annual cost of $155,424 and will be funded with current year salary savings (1991 Mental Health Realignment) and federal financial participation at up to 65 percent reimbursement for utilization review services.
ACCESS/Interdepartmental Multi-Disciplinary Team
In April of 2017 the Board established the strategic priority to strengthen the County’s safety net system. To further that priority, the safety net departments established an Interdepartmental Multi-Disciplinary Team consisting of front line staff from each of the participating departments to implement a coordinated system of care.
Since then, ACCESS Sonoma and the multi-disciplinary team have developed a master database and care coordination tool and have served more than 130 clients.
The ACCESS Sonoma project is at a critical phase. The goal going forward is to institutionalize ACCESS Sonoma and the interdepartmental team processes, to make them the way the county does business.
The Department is requesting the addition of a time-limited 1.00 full-time equivalent Health Program Manager to facilitate this process. The Health Program Manager will provide leadership in accomplishing this goal. The position will do the following:
- Develop policies and procedures based on the experience to-date
- Monitor and track the status of the project
- Facilitate Interdepartmental Multi-Disciplinary Team meetings and care coordination
- Enhance and expand the collaboration between the safety net departments and community partners
- Provide regular reports and updates to stakeholders
- Coordinate with the IBM team
- Establish and track performance-based metrics to evaluate processes and interventions to inform quality improvement activities
- Conduct outreach and education activities including making presentations about the ACCESS/Interdepartmental Multi-Disciplinary Team project
The annual cost of the position is $176,293 and will be funded with Whole Person Care grant funds ($88,147) and Homeless Mentally Ill Outreach and Treatment Program ($88,147) funding. Since these funding sources are time limited, the Department is requesting a time-limited position through December 31, 2022. Appropriations will be requested through the consolidated budget adjustments process.
Juvenile Sex Offender Program
Through a memorandum of understanding between the Department of Health Services and the Probation Department, the Behavioral Health Division will add a 1.00 full-time equivalent Behavioral Health Clinician Intern to provide services to participants in the Juvenile Sex Offender Treatment Program. The clinician will provide once weekly individual therapy, group therapy as indicated, and once a month family therapy. The annual cost of the position is $154,944 and will be fully funded by the Probation Department. Appropriations will be requested through the consolidated budget adjustments process.
Department of State Hospitals Mental Health Diversion
In recent years, California has seen a significant increase in referrals to the state hospitals of individuals who are incompetent to stand trial due to a mental illness. In response, the 2018-2019 state budget included $100 million for the expansion and development of county-based diversion programs. In developing their approach, the Department of State Hospitals identified 15 target counties with the highest number of referrals. Sonoma County was one of these counties.
The Department of State Hospitals has set aside $3.8 million for Sonoma County over a three year period for local mental health diversion services (about $1.3 million per year). The new program will be integrated into the existing forensic services. The new staff will be supervised by the existing Forensic Assertive Community Treatment Team Health Program Manager. The Department is requesting additional time-limited allocations including 1.00 full-time equivalent Behavioral Health Clinician Intern, 0.20 full-time equivalent Psychiatric Nurse, 1.00 Senior Client Support Specialist, and 0.20 full-time equivalent Staff Psychiatrist, at an annual cost of $350,843. Appropriations will be requested through the consolidated budget adjustments process.
It is expected that if the pilots are successful in reducing referrals and costs, that the Department of Health Services will make the funding ongoing. Given the relative uncertainty, the Department is requesting time-limited allocations.
Strategic Plan Alignment - Appropriately staffing Behavioral Health programs and aligning staff requirements with available funding supports the County’s goal of a Safe, Healthy, and Caring Community by ensuring that the County’s most vulnerable population has access to behavioral health services. In addition to alignment with the County’s Strategic Plan, Behavioral Health programs support the Department’s Strategic Plan goal of ensuring that individuals have access high quality and coordinated services for health, recovery, and well-being by strengthening the behavioral health infrastructure.
Prior Board Actions:
In March 2019 the Board received an update on the Department’s redesigned mental health system of care. In June 2019 the Board approved the fiscal year 2019-2020 County budget.
Fiscal Summary
|
Expenditures |
FY 19-20 Adopted |
FY 20-21 Projected |
FY 21-22 Projected |
|
Budgeted Expenses |
2,230,271 |
3,004,127 |
3,003,917 |
|
Additional Appropriation Requested |
837,505 |
|
|
|
Total Expenditures |
3,067,776 |
3,004,127 |
3,003,917 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
2,011,708 |
2,886,638 |
2,882,902 |
|
Fees/Other Graton Mitigation and R&R |
900,000 |
|
|
|
Use of Fund Balance: 1991 Mental Health Realignment |
156,068 |
117,489 |
121,015 |
|
Contingencies |
|
|
|
|
Total Sources |
3,067,776 |
3,004,127 |
3,003,917 |
Narrative Explanation of Fiscal Impacts:
The funding for these positions is provided by Board authorized funding, Federal Financial Participation, 1991 Realignment, 2011 Realignment, and Mental Health Services Act. There is use of MHSA and 1991 Realignment fund balance for one-time costs and costs that are not claimable to grants. The Department will come back during the consolidated budget adjustment process to add the requested appropriations for staffing and use of fund balance. Total appropriation request will be in the amount of $837,505. These appropriations are needed because the Department has received new funding from Probation and Department of State Hospitals and has also identified necessary positions that were not included in the 19-20 budget.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
Behavioral Health Clinician |
6,108 - 7,425 |
3.00 |
0 |
|
Health Program Manager |
7,128 - 8,663 |
1.00 |
0 |
|
Senior Client Support Specialist |
4,628 - 5,627 |
3.00 |
0 |
|
Senior Office Assistant |
3,628 - 4,411 |
3.30 |
0 |
|
Behavioral Health Clinician (time-limited through 12/1/2022) |
6,108 - 7,425 |
1.00 |
0 |
|
Health Program Manager (time-limited through 12/31/2022) |
7,128 - 8,663 |
1.00 |
0 |
|
Psychiatric Nurse (time-limited through 12/1/2022) |
7,232 - 8,790 |
0.20 |
0 |
|
Senior Client Support Specialist (time-limited through 12/1/2022) |
4,628 - 5,627 |
1.00 |
0 |
|
Staff Psychiatrist (time-limited through 12/1/2022) |
14,987 - 18,217 |
0.20 |
0 |
Narrative Explanation of Staffing Impacts (If Required):
The Department plans to begin the hiring process as soon as the position allocations become effective. The term of the time-limited Health Program Manager position will end December 31, 2022. The term of the remaining time-limited positions will end December 1, 2022.
Attachments:
Personnel resolution, Summary of Fiscal Year 2019-2020 Restoration Funds
Related Items “On File” with the Clerk of the Board:
None