Behavioral Health Services Staffing Allocation Request to BOS on Dec 3rd

Recommended Action:

A)   Adopt a personnel resolution amending the Department Allocation List of the Department of Health Services, adding 2.0 full-time equivalent Behavioral Health Clinician positions and 1.0 full-time equivalent Senior Client Support Specialist, effective December 3, 2024.

B)   Adopt a Resolution authorizing budgetary adjustments to the fiscal year 2024-2025 adopted budget, increasing appropriations in the Department of Health Services by $468,207 to reflect revenue and expenditures associated with the requested position allocations.

 (4/5th Vote Required)

Executive Summary:

As part of our response the California Department of Health Care Services’ Corrective Action Plan, Department of Health Services (DHS) management requests the addition of 2.0 full-time equivalent (FTE) Behavioral Health Clinician position allocations for the Behavioral Health Adult Access Team (not to be confused with ACCESS – Accessing Coordinated Care and Empowering Self Sufficiency – which is a separate program of the same name located in the Homelessness Services Division). These positions will provide Behavioral Health Assessments, case-management, and referrals for clients requesting services through the Access Team.

Additionally, the Youth and Family Services section of the Behavioral Health division within DHS is requesting approval from the Board to add 1.0 FTE Senior Client Support Specialist (SCSS) to staff the mandated Child and Family Team Meetings for youth who qualify for Intensive Care Coordination and Intensive Home-Based Services. These positions will leverage Medi-Cal Federal Financial Participation and Medi-Cal Administrative Activities, with approximately 50% matching funds provided by the Mental Health Services Act (MHSA).

Discussion:

Access Team – 2.0 FTE Behavioral Health Clinicians

The Behavioral Health Adult Access Team under the Adult Services unit is the first contact for clients requesting mental health services and are responsible for providing initial assessment and case-management services for clients requesting services with Behavioral Health. Access team assessors determine the level of need for mental health services, provide assessment, linkage, and information and referral for mental health services for children, youth, and adults. Clients qualify for different levels of care based upon these assessments.

The California Department of Health Care Services (DHCS) requires that the initial service appointment for new clients be offered within 10 business days of request. The current volume of requests has exceeded the existing capacity of the assessors and is resulting in timeliness issues, with some requestors waiting 6 weeks for their initial assessment. DHCS issued a Corrective Action Plan (CAP) on 4/26/23 regarding this issue during DHS’ last annual network certification; but despite adding additional 1.5 FTE of case-management coverage on the team in the Spring of 2024, the volume continues to exceed assessor capacity. DHCS issued a new CAP finding on 10/7/24, identifying timeliness to services as the leading issue.

Additionally, DHS has been approved to implement the Drug Medi-Cal Organized Delivery System (DMC-ODS) waiver starting in December. Based upon feedback from other bay-area counties, DHS anticipates an initial 50% increase in request volume that will taper off within the first quarter to an average of an ongoing 25% increase in request volume.  Currently there are 5.0 Assessor FTEs on the Access Team, and 2.0 Senior Client Support Specialist FTE (to perform case-management). Each Assessor FTE can handle 20 new Assessments per month, plus a 30-member ongoing caseload. The current volume of inquiries is 200 per month, with 75% resulting in Assessment; and is anticipated to increase to an ongoing 175-200 Assessments needed per month after DMC-ODS. As such, DHS is requesting the addition of 2.0 FTE Behavioral Health Clinicians to improve the current wait time concerns, as well as in anticipation of the ongoing increase resulting from DMC-ODS. 

This request is also responsive to the programmatic changes necessitated by the California Advancing and Innovating Medi-Cal (CalAIM) directives and the expansion of Substance Use Disorder Services through DMC-ODS.

Behavioral Health Clinicians perform duties which include, but are not limited to, the following: conduct comprehensive assessments to diagnose mental health conditions; develop treatment plans to authorize and guide specialty mental health services; provide emergency interventions in the field; provide a variety of case management and therapeutic support services to clients; may provide transportation, placement assistance, advocacy, and skills coaching for activities of daily living and other client support services; collaborate with other client-serving agencies to ensure the most supportive environment for each client; and perform related duties as required.

Youth and Family Services – 1.0 FTE Senior Client Support Specialist

Child and Family Teams (CFTs) within the Youth and Family Services section of the Behavioral Health division within DHS bring together loved ones and experts to support the child in reaching their potential and are dedicated to helping the family thrive. CFTs draw on a child’s and family’s strengths, experiences, knowledge, and network of support to create a plan for the safety, stability, and well-being of the children and family. The CFT process is intended to be inclusive of multiple formal support systems a family may need, as well as the informal, community, and natural supports that surround a family. CFTs are a required service for foster youth meeting the Katie A subclass, and for children who screen as qualifying for Intensive Care Coordination and Intensive Home-Based Services.  These children are the higher needs children serviced by our system, many of whom are involved in multiple systems such as Behavioral Health, Child Welfare, or Juvenile Probation.

DHS is currently on a 2021 Corrective Action Plan with DHCS because the division is not facilitating any Child and Family Team Meetings for youth who qualify for Intensive Care Coordination and Intensive Home-Based Services. 

These services are mandated by DHCS as part of the Mental Health Plan, and provide required and mandated Early and Periodic Screening, Diagnostic and Treatment services to youth. DHS has never had staff to provide this requirement. Youth and Family Services will need to provide approximately 1,600 CFTs per year. 1.0 FTE SCSS can provide approximately 350 CFTs per year. 

There are not currently any staff available to provide these required and mandated services. Adding this 1.0 FTE SCSS will bring the total SCSS allocated to Youth and Family Services to 2.0 FTE (the second FTE is an underfill using an existing position) and will enable Youth and Family Services to begin providing the required services to children, including foster youth and youth on our Full Service Partnerships; the Family Advocacy, Stabilization and Support Team; and Transitional Age Youth. These 2.0 FTE SCSS will be able to provide close to half the required CFTs. DHS is planning to request addition staff next fiscal year to address the shortfall.