To: Board of Supervisors
Department or Agency Name(s): Human Services, Department of Health Services
Staff Name and Phone Number: Paul Dunaway 565-3673, Gary Fontenot 565-5931
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Mental Health Services Act, Collaborative Care Enhanced Recovery Project
End
Recommended Action:
Recommended action
A) Adopt a budget resolution to accept revenue in the amount of $998,558 from the Department of Health Services for the Mental Health Services Act Innovations grant program, Collaborative Care Enhanced Recovery Project through August 31, 2024, and authorize an adjustment to the Human Services Department’s Fiscal Year 2021-2022 budget in the amount of $269,290.
B) Authorize the Director of the Human Services Department to execute a contract with Santa Rosa Community Health for a total of $480,273 for the grant period of September 1, 2021-August 31, 2024, and to amend and execute future contract amendments to accept unanticipated revenues that do not increase the amount of the contract by more than $50,000 from the original amount or significantly change the scope of service. The community benefit of this initiative includes: improved health outcomes, reduced healthcare costs and increased overall quality-of-life among low-income county residents (with a special equity lens and focus on Latinx older adults.)
C) Adopt a position resolution to:
i. Add 1.0 full-time equivalent (FTE) time-limited Social Service Worker IV position through August 31, 2024 in support of the Collaborative Care Enhanced Recovery Project
ii. Extend an existing 1.0 FTE time-limited Program Planning and Evaluation Analyst position from June 30, 2022 to August 31, 2024
(4/5th Vote Required)
end
Executive Summary:
The Human Services Department (HSD) was selected to received funding in the amount of $998,558 from the Department of Health Services for the Mental Health Services Act (MHSA) Innovations grant program, Collaborative Care Enhanced Recovery Project. HSD is seeking approval from the Board of Supervisors to accept the funding and adjust the HSD FY 2021-2022 budget.
HSD is also seeking approval to contract with Santa Rosa Community Health for a total of $480,273 for the grant period from September 1, 2021 through August 31, 2024 to fulfill the deliverables of Collaborative Care Enhanced Recovery Project.
In order to successfully implement the MHSA Innovations Project, HSD is seeking approval to: A) Add 1.0 FTE time-limited Social Service Worker IV through August 31, 2024; and B) Extend an existing time-limited 1.0 FTE Program Planning and Evaluation Analyst (PPEA) from June 30, 2022 to August 31, 2024.
The community benefits from this initiative by improving health outcomes, reducing healthcare costs and increasing overall quality-of-life among low-income county residents (with a special focus on Latinx older adults). Outcomes will be accomplished by: A) Navigating those identified with depression into a primary care health home with integrated behavioral health services and extended in-home and clinical case management; B) Connecting clients to resources that help address other factors contributing to poor physical/behavioral health outcomes (e.g., access to food/shelter); and C) Expanding the bilingual/bicultural behavioral health workforce.
Discussion:
In 2019, the County of Sonoma Department of Health Services (DHS) conducted a Request for Proposal (RFP) for MHSA Innovations projects. The HSD, Adult and Aging Division (A&A) partnered with Santa Rosa Community Health (SRCH) to apply for the funding to support the Collaborative Care Enhanced Recovery Project: Advancing Older Adult Depression Care through Extended Supportive Services (CCERP).
In December 2020, DHS preliminarily notified HSD and SRCH that the CCERP grant application was selected to move forward in the amount of $998,558 for a 3-year term. In February 2021, the Board of Supervisors approved the CCERP project (along with other local MHSA Innovations Projects) to move forward to the California Mental Health Services Oversight and Accountability Commission (MHSOAC) for state-level approval. In late May 2021, the MHSOAC approved the CCERP project for implementation.
This new 3-year project builds on the Comprehensive Collaborative Care Model (CoCM) that A&A implemented in 2015 in partnership with Petaluma Health Center, West County Health Centers and West County Community Services. This evidence-based model integrates physical and behavioral health services to achieve better patient outcomes while reducing healthcare costs among those age 65 and older, and serves as the foundation for this Innovations Project.
Background
Sonoma County is experiencing a profound demographic shift with approximately 4 out of 10 residents (approximately 200,000 individuals) age 50 and older. One quarter of the county’s overall population is Latinx and the same proportion of residents report that English is not their primary language.
Santa Rosa is home to a disproportionate number of low-income and aging residents where unaddressed behavioral health disorders, unmanaged chronic health conditions, and compromised social determinants of health such as substandard housing, food insecurity, and neighborhood crime converge. Demand for behavioral health services rises as adults age and these socioeconomic challenges exacerbate the need for support in the areas of behavioral health, health and overall well-being.
Social isolation and loneliness experienced by older adults is associated with higher rates of depression, high blood pressure, uncontrolled diabetes, and cognitive decline. However, Latinx seniors are less likely to seek behavioral health care due to issues such as stigma, cost, and shortage of bilingual/bicultural service providers.
Intervention
HSD, A&A and SRCH will pilot a modification to CoCM by: A) Expanding the cohort of program beneficiaries to include those ages 50-64; B) Focusing on bilingual/bicultural outreach, education, and services to Latinx community members; and C) Increasing in-home case management services from three months to one year.
The project proposes that at least 225 unduplicated patients served at SRCH’s Lombardi Campus, (located in a neighborhood with a population of 43% Latinx community members), will receive comprehensive, coordinated, patient-centered care delivered by a multidisciplinary team. The team is comprised of an A&A care manager/home visitor and members of the SRCH’s clinical team, including a primary medical care provider, a mental/behavioral health care provider, and a patient navigator. They will address and track patients’ depression, physical health conditions, and social determinants of health in a culturally and linguistically appropriate manner.
Project Goals
CCERP’s three primary goals are to measure:
1) Levels of sustained improvement in depression symptoms of patients
2) Patients’ appropriate use of preventive health care
3) The effectiveness of the multidisciplinary approach within the Latinx community
Assessment of this new approach will include tracking of patients’: 1) engagement in the program for the full 12 months; 2) improvement in mental health status; 3) positive health care utilization and associated health outcomes; 4) decrease in self-reported social isolation; 5) advances in addressing social determinants of health; 6) reduced health access and outcome disparities compared to non-Latinx counterparts. These data sets will contribute to the analysis of project impact and will inform program improvements as well as the planned expansion to SRCH’s three other large campuses.
Community Involvement
A&A and SRCH are committed to meaningful involvement with a diverse community of stakeholders for CCERP. Both agencies have solicited confidential input from social workers and consumers, and the planned intervention reflects their collective input. These advisors’ continued engagement is built into the project’s operational plan, with the formation of an Older Adult Steering Committee comprised of consumers, service providers, project staff and social workers, and adult community members ages 50-64, with a focus on Latinx stakeholders that the Committee will meet regularly to track project progress and provide strategic guidance to the project.
Prior Board Actions:
February 23, 2021 - Board of Supervisors approved the MHSA Innovations Project proposals as required by the Mental Health Services Oversight and Accountability Commission, which included 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
Expenditures |
FY 21-22 Adopted |
FY 22-23 Projected |
FY 23-24 Projected |
Budgeted Expenses |
|
$336,102 |
$349,611 |
Additional Appropriation Requested |
$269,290 |
|
|
Total Expenditures |
$269,290 |
$336,102 |
$349,611 |
Funding Sources |
|
|
|
General Fund/WA GF |
|
|
|
State/Federal |
$269,290 |
$336,102 |
$349,611 |
Fees/Other |
|
|
|
Use of Fund Balance |
|
|
|
Contingencies |
|
|
|
Total Sources |
$269,290 |
$336,102 |
$349,611 |
Narrative Explanation of Fiscal Impacts:
The FY 2021-22 requested budget adjustment is $269,290, comprised of Mental Health Services Act Innovation funding.
The FY 2021-22 appropriation of $269,290 will pay for the pro-rated payroll cost of $106,300 for the addition of 1.0 FTE Social Service Worker IV and $133,400 in Santa Rosa Community Health contract expenses in FY 2021-22.
Funding to pay for labor and contract cost in subsequent fiscal years through August 31, 2024 will be primarily covered by the remaining Mental Health Services Act Innovation funding of $729,628; and $367,015 in other State and Federal sources will fund the remainder of costs through August 31, 2024. No County General Fund match is required.
Staffing Impacts: |
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
Social Service Worker IV |
$5,922.20 - $7,198.82 |
1.0 |
0.0 |
Program Planning and Evaluation Analyst |
$6,572.69 - $7,988.45 |
Extend 1.0 |
0.0 |
|
|
|
|
Narrative Explanation of Staffing Impacts (If Required):
The time-limited Social Service Worker IV position (assigned to the MHSA Innovations Project) will report to a Social Service Supervisor II.
The time-limited Program Planning and Evaluation Analyst, assigned to this MHSA Innovations Project will report to the Adult and Aging Section Manager.
Attachments:
Attachment 1 - Budget Resolution
Attachment 2 - MHSA Innovations Contract with Santa Rosa Community Health
Attachment 3 - Positions Resolution
Related Items “On File” with the Clerk of the Board:
N/A