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
Crisis Care Mobile Units Funding Agreements
End
Recommended Action:
Recommended action
A) Authorize the Director of Health Services, or designee, to execute a revenue agreement with Advocates for Human Potential, Inc. (state contractor) to accept revenue to support local mobile support team programs in the amount of $2,498,898.69, including $1,929,788.69 for infrastructure through June 30, 2025 and $569,120 for limited direct services through February 14, 2023, and to execute amendments and modifications to said agreement.
B) Authorize the Director of Health Services, or designee, to execute funding agreements with the cities of Cotati, Rohnert Park, Petaluma, and Santa Rosa for a total amount not-to-exceed $2,248,787 through June 30, 2025.
C) Adopt a resolution authorizing budgetary adjustments to the fiscal year 2022-2023 adopted budget to program funding available to support the Crisis Care Mobile Units Program in the amount of $1,829,099. (4/5th Vote Required)
end
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 (CCMU) Program funding. On November 10, 2021, DHS received notification of an award in the amount of $2,498,898.69 for the period September 15, 2021 through June 30, 2025. The 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 Program is designed to provide $1,929,788.69 for infrastructure through June 30, 2025 and $569,120 for limited direct services through February 14, 2023 to expand mobile behavioral health crisis services.
Advocates for Human Potential, Inc. (AHP) is the primary contractor assisting DHCS in administering CCMU Program funds. To receive revenue for the CCMU Program, the County, as a subcontractor to AHP, is required to enter into an agreement with AHP.
The Department plans to provide pass-thru funding to partner jurisdictions to finance infrastructure costs that support implementation of mobile crisis services programs. Rohnert Park and Cotati will receive a total of $916,630 to support establishment of their joint program. Due to an established MOU about funding related to the program, this award will be split between the two cities at 86% Rohnert Park and 16% Cotati: $769,968 to Rohnert Park and $146,662 to Cotati. The City of Petaluma Specialized Assistance for Everyone (SAFE) program will receive $916,629 to expand services. Finally, the City of Santa Rosa will receive $415,528 for support of the inRESPONSE program. These funding agreements will provide funding in addition to the $941,887 Measure O funded agreements approved by the Board on October 26, 2021.
Of the total grant award, $250,112 will be used by DHS to administer and manage the grant and establish a collaborative program outcome and evaluation workgroup, all of which will be led by staff in the DHS Health Policy, Planning and Evaluation (HPPE) Unit through the end of the grant in June 30, 2025.
To mechanize state funding available through AHP and associated pass-thru funding agreements with the cities, this item requests approval of a budget adjustment to the fiscal year 2022-2023 adopted budget in the amount of $1,829,099, including fiscal year 2022-2023 expenditures of $1,175,795 and fiscal year 2021-2022 estimated expenditures of $653,304. Fiscal year 2021-2022 is included as the grant is back dated to September 2021 and the scope of work used in the contract lays out expenses dating back to September 15, 2021. Allowing for the grantee to request payment for past expenses incurred listed in the scope of work upon execution of the grant agreement. In addition, funding from SAMHSA is only eligible for expenditures until February 14, 2023. Not allowing for the back dating of expenses limits the ability to fully utilize these funds and not claim expenses that have incurred that are reimbursable by the grant.
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. However, it has been the intention of Sonoma County to eventually serve all geographic regions with 24/7 mobile crisis services.
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 development of other collaborative city/county efforts. The Petaluma Specialized Access for Everyone (SAFE) program operated by Petaluma Peoples 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 (DHS), Buckelew Programs, and Catholic Charities, which launched in January 2022.
The cities of Rohnert Park and Cotati worked with a crisis consultant to assist in getting their alternative response unit up and running. The cities of Petaluma, Rohnert Park, and Cotati have 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.
An earlier recommendation to your Board regarding a commitment of funds to mobile crisis was to wait for the outcome of state grant opportunities that would support mobile crisis efforts. Since that recommendation, DHS partnered with Santa Rosa, Petaluma, Rohnert Park, and Cotati to apply to the California State Department of Health Care Services (DHCS) Crisis Care Mobile Units (CCMU) grant program. DHS has received approval for funding in the amount of $2,498,898.69. The CCMU award requires that 75 percent of the funds at minimum be committed to infrastructure costs and 25 percent at maximum set aside for services to individuals who do not have insurance coverage or are underinsured. Rohnert Park and Cotati will receive a total of $916,630 to support establishment of their program, including $769,968 to Rohnert Park and $146,662 to Cotati. The City of Petaluma Specialized Assistance for Everyone (SAFE) program will receive $916,629 to expand its services. Finally, the City of Santa Rosa will receive $415,528 for the launch of the inRESPONSE program.
Of the total grant award, $250,112 will be used to by DHS to support the grant and establish a collaborative program outcome and evaluation workgroup led by the DHS Health Policy, Planning and Evaluation (HPPE) Unit. This expenditure will be shared equally across all three teams (Santa Rosa, Petaluma, and Rohnert Park/Cotati) at $83,370.67 per team. Within this project, Sonoma County Mobile Support Team (MST), Santa Rosa inRESPONSE, Petaluma SAFE and Rohnert Park/Cotati mobile crisis programs will share common data definitions, data platforms, and analyses to ensure that the cities and county are identifying lessons learned from their programs to support program quality improvement, as well as the expansion of these enriched mobile crisis services across all of Sonoma County’s communities. Included in this sum will be the cost to pay for consultants to provide services related to data collection and evaluation. For example, a software vendor selection process with the goal to find a common software solution for data capture across all teams that will be Health Insurance Portability and Accountability Act (HIPAA) compliant and fit the data needs of the teams. The cost of the software vendor selection consultant is not expected to exceed $50,000. The vendor will be selected after the execution of this contract.
CCMU Funding Summary
Advocates for Human Potential, Inc. (AHP) is the primary contractor assisting DHCS in administering CCMU Program funds. To receive revenue for the CCMU Program, the County, as a subcontractor to AHP, is required to enter into an agreement with AHP. Grant funding from the agreement with AHP will support funding the cities of Cotati, Rohnert Park, Petaluma, and Santa Rosa to support the advancement of their respective mobile support team programs in the amounts shown in Attachment 1. The requested action associated with the AHP agreement includes approval to execute amendments and modifications to the agreement with AHP to accommodate language in the agreement stating that AHP may make unilateral changes, within the general scope of the agreement, in the definition, time of performance, or quantity of services to be performed.
These funds may be used by the cities to cover start-up and operational costs not covered by other funding sources, including a common database, vehicles, technology, and other needed infrastructure. Planned use of the funds are detailed in the draft agreement with AHP, provided as Attachment 2. The final agreement with AHP will be substantially similar to the attached draft agreement.
To support acceptance of revenue from the agreement with AHP and the expenditures associated with the funding agreements with the cities, this item requests approval of a budget adjustment to the fiscal year 2022-2023 adopted budget in the amount of $1,829,099, including fiscal year 2022-2023 expenditures or $1,175,795 and fiscal year 2021-2022 estimated expenditures of $653,304 to reimburse the cities for costs incurred for startup and operations identified as acceptable expenses in the details provided in Attachment 4.
DHS is working 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. DHS will be returning to the Board with an assessment and recommendations for potentially expanding services in Spring 2023.
References:
CCMU Program - <https://www.infrastructure.buildingcalhhs.com/crisis-care-mobile-unit-ccmu-awards/>
Prior Board Actions:
On 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 Cotati/Rohnert Park and Petaluma each 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 in January - December 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
|
Expenditures |
FY 22-23 Adopted |
FY 23-24 Projected |
FY 24-25 Projected |
|
Budgeted Expenses |
|
$440,132 |
$229,668 |
|
Additional Appropriation Requested |
$1,829,099 |
|
|
|
Total Expenditures |
$1,829,099 |
$440,132 |
$229,668 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
$1,829,099 |
$440,132 |
$229,668 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
$1,829,099 |
$440,132 |
$229,668 |
Narrative Explanation of Fiscal Impacts:
The Department is requesting $1,829,099 in appropriations for FY 2022-2023, including FY 2022-2023 expenditures of $1,175,795 and FY 2021-2022 estimated expenditures of $653,304, via the attached budget resolution (Attachment 3). Of the total $1,829,099, $569,120 is sourced from SAMHSA and must be expended by February 14, 2023. The remaining $1,259,979 comes from BHCIP and can be expended anytime during this period. Future year appropriations, including $440,132 for FY 2023-2024 and $229,668 for FY 2024-2025, will be included in the Department’s recommended budget are all sourced from BHCIP funds which must be expended by June 30, 2025.
|
Staffing Impacts: |
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|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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|
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - CCMU Funding Summary
Attachment 2 - Agreement with Advocates for Human Potential
Attachment 3 - Budget Resolution
Attachment 4 - CCMU Program Funding Fact Sheet
Related Items “On File” with the Clerk of the Board:
None