Coming up soon at the Sonoma County Board of Supervisors will be the adoption of the FY 23-24 Measure O Annual Report, and $4 million more Measure O NOFA Awards for FY 25-26. Two more NOFAs will be announced by the Department of Health Services in the next four months from Measure O and from Opioid Settlement funds. Both total almost $25 million.
Author: Gregory Fearon
Upcoming Public Actions
On Tuesday (tomorrow), the Board of Supervisors will be acting on two Consent Agenda items which have the ability to expand service and housing for residents served by the County:
- (Item #9) Bond Behavioral Health Continuum Infrastructure Program Round-1 Grant Application Resolution Update. Adopt a Resolution to replace Resolution 24-0519 authorizing the Director of Health Services, or designee, to apply to the California Department of Health Care Services’ Behavioral Health Continuum Infrastructure Program Round 1 (BHCIP 2024) Launch Ready Program Request for Applications, increasing the application amount by $10,202,227.50 for a new not-to-exceed amount of $67,702,227.50 for the construction of four Mental Health Rehabilitation Centers and one Adult Residential Substance Use Disorder Treatment Facility.
- (Item #11) New positions to support California Advancing and Innovating Medi-Cal (CalAIM). A) Adopt a Resolution amending the Sheriff’s Office Department Allocation List to add 1.0 Full Time Equivalent (FTE) Administrative Aide, effective February 4, 2025, to support the mandated California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved Initiative. B) Adopt a Resolution amending the Department of Health Services Department Allocation List to add 2.0 Full Time Equivalent (FTE) Senior Client Support Specialists, effective February 4, 2025, to support the mandated California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved Initiative.
- In 2023, California became the first state in the nation approved to offer a targeted set of Medicaid services to youth and adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release with the goal of addressing the unique and considerable health care needs of justice-involved individuals, improving health outcomes, delivering care more efficiently, and advancing health equity across the state.
- Through a federal Medicaid 1115 demonstration waiver approved by the Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) has partnered with state agencies, counties, and community-based organizations to establish an expanded system for providing enhanced care. Implementation of the mandated expansion in services, called California Advancing and Innovating Medi-Cal, or CalAIM, involves establishing a reentry process that provides incarcerated adults with the physical and mental health services they need before release, and connecting them to appropriate service providers for care upon reentry to the community.
- Eligible inmates will receive services up to 90 days before their release to stabilize their behavioral health conditions and establish a plan for their community-based care. The Sheriff’s Office intends to go-live with the provision of enhanced services in January 2026. The deadline to go live is September 30, 2026.
On Wednesday, there are three meetings that are central to the work of providing direction to County and community services for homeless, mentally-ill, and addicted residents in Sonoma County.
- Behavioral Health Board Executive Committee, 10:30am, 2227 Challenger Way, Room 201. Planning meeting for the Full BHB meeting on Feb 18th.
- MHSA Program Steering Committee, 1-3pm, 2227 Challenger Way, Galaxy Room (next to Room 201)
- Measure O Oversight Committee, 4-5:30pm, 1450 Neotomas Ave, Suite 200. Quarterly meeting to review finances and progress on programs funded.
On January 28th, the Santa Rosa City Council considered, and then delayed approval of a an application to the State of California Department of Housing and Community Development’s HomeKey+ Grant Program for the City to be a co-applicant with Burbank Housing Development and Caritas Homes Phase II LLC in an amount not to exceed $13.95 million. The grant is for the development of permanent supportive housing for individuals or households with an individual who is homeless, chronically homeless, or at risk of homelessness and who are also living with a behavioral health challenge. Caritas Homes Phase II, the final stage of the Caritas Village project located in downtown Santa Rosa will add 30 new affordable apartments reserved for homeless individuals referred through the Sonoma County Coordinated Entry system, meets the eligibility criteria for HomeKey+ funding. The item was pulled from the City Council agenda, and will be rescheduled at a later date.
Sonoma County Measure O Meeting Fund Balance Report
Last October, the County told our Oversight Board it had plans to spend $44 million this fiscal year, and $46 million in the next one. They were responding to pressure from many to exhaust the tax-fed five buckets, and fund balances, of money that the voters have been contributing since November of 2020. The latest financial report (as of 1/24/25) distributed to us for our February 5th meeting indicates the County has spent $18 million of $19 million available in the second largest bucket (Behavioral Health Facilities) primarily by: 1) building and operating a 16-bed psychiatric health facility (Crestwood) at Los Guillicos, one of only nine in the state; and 2) contracting with 18 long-term residential care facilities in and out of Sonoma County. Of the largest bucket of money ($38.5 million for Emergency Psychiatric/Crisis Services), about two-thirds have been spent ($$25.8 million). Of the third largest bucket (Mental Health and Substance Use Disorder Outpatient Services), only $350,000 of the $15.8 million has been spent. In the second smallest bucket (Behavioral Health Homeless/Care Coordination), $8 million of the $12 million available has been spent. And in the smallest bucket (Transitional and Permanent Supportive Housing), $1 million of the $1.6 million has been spent. As a result, the total fund balance for all of the buckets is down by only $1.8 million, instead of the $11 million drop we had planned to spend. Do we still feel confident we can catch up in the next five months? And what about our plans to lower it by another $14 million next year?
Behavioral Health Transformation Beginning
Among the New Year’s obligations mandated by the voters of California are the requirements placed on counties to transform its planning and delivery of mental health and substance use disorder services. New expectations are in place to conduct countywide research involving a wide range of stakeholders to develop integrated global spending plans for the use of all county revenues.
Bringing together dozens of individual program efforts, authorized and monitored from many different state and federal initiatives stretching back many decades, this new Behavioral Health Services Act (Behavioral Health Transformation) reforms behavioral health funding to prioritize services for people of all ages with the most significant mental health needs while adding the treatment of substance use disorder (SUD), expending housing interventions, and increasing the behavioral health workforce. It also enhances oversight, transparency, and accountability at the state and local levels.
The Behavioral Health Services Act builds on many strategies to meet community needs for culturally responsive services that improve health and reduce health disparities for all, including:
- Reducing the silos for planning and service delivery.
- Requiring stratified data and strategies for reducing health disparities in planning, services, and outcomes.
- Advancing community-defined practices as a key strategy for reducing health disparities and increasing diverse community representation.
Sonoma County, through its Department of Health Services, will develop a Three-Year Integrated Plan, which must be developed in partnership with local stakeholders through a process that incudes meaningful stakeholder involvement in mental health and substance use disorder policy, program planning, and implementation, monitoring, workforce, quality improvement, health equity, evaluation, and budget allocations. Integrated Plans will include a demonstration of how the County will utilize various funds for behavioral health services to deliver high-quality, culturally responsive, and timely care along the continuum of services in the least restrictive setting from prevention and wellness in schools and other settings to community-based outpatient care, residential care, crisis care, acute care, and housing services and supports.
Three Local Funding Categories
Local behavioral health agencies are required to develop detailed plans for the use of BHSA funds in each of the following components, then submit those plans to the Behavioral Health Services Oversight and Accountability Commission (BHSOAC), and the CA Department of health Care Services (DHCS) for approval.
- Housing Interventions
- 30% of local BHSA funding shall be dedicated to housing interventions for people living with serious mental illness/serious emotional disturbance and/or substance use disorder who are experiencing homelessness.
- Funding can be used for thee full spectrum of housing services and supports, rental subsidies, operating subsidies, and non-federal share for Medi-Cal covered services, including clinically-enriched housing. Zit can also be used to further the California BHCONNECT.
- Funding may also be used for capital development projects, subject to DHCS limits.
- Full Service Partnerships
- 35% of the local assistance for Full Partnership (FSP) which should be optimized to leverage Medicaid as much as possible. FSPs include comprehensive and intensive care for people at any age with the most complex needs (also known as the “whatever it takes” model).
- Behavioral Health Services and Supports (non-FSP) and Additional Components
- 35% for other services including Behavioral Health Services and Supports (non-FSP), Outreach & Engagement, Prevention and Early Intervention*, Capital Facilities and Technological Needs, Workforce Education and Training, and prudent reserve.
* A county shall utilize at least 51percent of Behavioral Health Services and Supports funding for early intervention programs and of that 51 percent, 51 percent must be allocated for early intervention programs to serve individuals who are 25 year of age and younger.
Preparing for a New Administration
I attended the all-day meeting of the Board of Supervisors and Department Directors on Friday at the Sebastopol Vets Bldg. The biggest single set of conclusions is that the BOS is preparing fo the Trump administration to: 1) deport residents, which may cause a reduction in the use of (and payment for) County services by those who fear that programs will share their information with ICE; 2) reduce funding for many local programs serving all of our residents; 3) deny reimbursement for much of the Covid19 service delivery undertaken by the County through DEMA; 4) reexamine the pace of the allocation of any local revenues and reserve funds in anticipation of their need to respond to the conditions described above.
It was clear that most in the room were encouraging the Board to both proceed with its generally progressive moral and fiscal agenda for the next year, and also be prepared to use its revenues and talents to prepare for the chaos and abandonment represented by the intentions of the Trump Administration.
Measure O Annual Update
There is a Dec 10th Report to the Board of Supervisors from the Department of Health Services titled ” Measure O Update for Fiscal Year 2023-2024” which updates them on the progress of Measure O, our sales tax-funded Behavioral Health and Homeless Community Solutions Initiative.
Executive Summary: The Sonoma County Board of Supervisors requested an update on Measure O during the June 2024 Budget hearings. This update covers fiscal year 2023-2024 expenditures by category; estimated fund balance for fiscal year 2024-2025 and fiscal year 2025-2026; and provides a review of outcomes and numbers served from last fiscal year. Additionally, staff will highlight Measure O successes and discuss the approach for current and future Measure O funding.
Discussion: In November 2020 Sonoma County voters passed Measure O to provide essential funding for mental health and homeless services with 68.07% of the vote. Measure O, a one-quarter cent sales tax, was estimated to generate over $25 million each year for ten years to help protect essential mental health and homelessness services.
The Measure O Sales Tax Ordinance identified five categories of services to be funded with the revenue: 1) Behavioral Health Facilities, 2) Emergency Psychiatric and Crisis Services, 3) Mental Health and Substance Use Disorder Outpatient Services, 4) Homeless Behavioral Health and Care Coordination, and 5) Transitional and Permanent Supportive Housing. The Measure O Expenditure Plan designates a set percentage of funding for each category.
On December 7, 2021, the Board of Supervisors established a Citizen’s Oversight Committee to monitor the implementation of Measure O. The Citizen’s Oversight reviews expenditures for alignment with the intent of the Measure and does not make or recommend funding decisions.
On October 23, 2024, the committee voted to confirm that the Measure O expenditures for Fiscal Year 2023-2024 met the intent of the measure. This past fiscal year was the 3rd full year of Measure O funding. Tax revenues for the year again exceeded the initial projections made when voters considered Measure O. Tax receipts totaled $32 million as opposed to the initially projected $24 million (total revenues including interest and unrealized gains was $34.2 million) The surplus has provided capacity to pursue expanded opportunities within the established categories to support our community.
For Fiscal Year 2023-2024, below are the Measure O funds used/spent by category: · Behavioral Health Facilities: $7,055,539 · Emergency Psychiatric & Crisis Services: $12,425,458 · Mental Health & Substance Use Disorder Outpatient Services: $1,275,496 · Behavioral Health Homeless & Care Coordination: $7,842,652 · Transitional & Permanent Supportive Housing: $3,345,616 The total projected Measure O revenue for FY 2024-2025 is $32,865,501.
In FY 24/25 a total of $66.2M of Measure O resources are available for programming, financed with $33.3 in fund balance and $32.9M of total revenues. The approved FY24-25 budget includes $37.5 million in expenditures for Measure O. The Department will be seeking $10.2 in additional appropriation in FY 2024-2025 Q4. Given the total planned expenditures of $47,739,541 for FY 2024-25 budget, the ending fund balance in June is projected to be $18,478,541.
Details of the various expenses by categories with additional information can be found in Attachment A Presentation.
The Mobile Support Team and Crisis Assessment Prevention and Education described below highlight recent updates from the Measure O-funded Mobile Support Team (MST) and Crisis Assessment Prevention & Education (CAPE).
· In December 2022, California Department of Health Care Services (DHCS) established a new Medi-Cal benefit providing 24/7/365 community-based mobile crisis intervention services to those experiencing a behavioral health crisis. On April 16, 2024, county staff launched Sonoma County’s 24/7 call center and a revamped Mobile Support Team (MST) to meet this need. The MST is partnering with SAFE (which serves Petaluma, Rohnert Park, Cotati and Sonoma State University) and inRESPONSE (which serves Santa Rosa)) to provide countywide coverage. The Sonoma County 24/7 call center and revamped MST is available to all Sonoma County residents regardless of insurance status. An additional $5M in Measure O funds are being held for contingencies from potential MST expansion based on future county and Regional Model City needs. The actual draw on the fund balance will be recalculated based on Federal Financial Participation action receipts from the Medi-Cal program.
· Crisis Assessment Prevention & Education (CAPE). CAPE provides school-based behavioral health support and interventions to schools in Sonoma County. Four mental health teams are strategically located across the county. CAPE is reinstituting in-person response to students experiencing behavioral health crisis and linking students to substance use disorder treatment services for to youth and young adults.. The program is active and expanding, providing services such as: direct linkage to County Behavioral Health services and navigating other health insurance to connect to treatment; substance use and suicide prevention and early intervention – educational presentations and campaigns, linkage, and referral; and peer support and groups. In the 2024-2025 school year , CAPE will be partnering with these schools: Analy High School and Laguna High School in West County; and Sonoma Valley High School, Creekside High School, Adele Harrison Middle School, Alta Mira Middle School, and Hanna Boys Center in the Sonoma Valley.
Successful Outcomes from Measure O
The Psychiatric Health Facility (PHF) has continued to operate at its full capacity of 16 beds, serving over 150 individuals annually due to Measure O funding.
The Crisis Stabilization Unit (CSU) served nearly 1,000 individuals and was also able to continue operations at full capacity due to Measure O until the current temporary closure due to facility issues. The Mobile Support Team has expanded into a Regional Collaboration that utilizes exciting new approaches to crisis response.
Measure O has also laid the groundwork for new programs launching this year, including CAPE, additional support for the Valley of the Moon Short Term Residential Treatment facility, and the expansion of Medi-Cal drug service.
This year also saw the finalization of incorporating Homelessness Services into DHS with Measure O providing 100% of funding for the Homeless Encampment Assistance and Resource Team (HEART) and Solving Obstacles for Unsheltered Lives (SOUL) programs, and a significant amount of funding ($4.2M) for George’s Hideaway. The George’s Hideaway project is a Permanent Supportive Housing (PSH) Project Homekey site near Guerneville. Measure O funds were used to support site renovation (including planning, water/sewer, and demolition work) under oversight of the Community Development Commission (CDC). This site will provide supportive care including therapy, substance use disorder care, benefit navigation, job training and life skills.
Also, in September of this fiscal year, the funds allowed for the release of the Measure O: Behavioral Health & Homelessness Community Solutions Notice of Funding Availability (NOFA) in the amount of $5.6 million, including $4.2 of Measure O funding and $1.4 million in Homeless Housing, Assistance and Prevention (HHAP) funding. The NOFA is open to applications from interested parties, community partners and any other local government agencies. The NOFA covers multiple program areas within each Measure O category with a specific focus on areas of identified need including on service navigation, staffing shortages, education/training and upstream approaches, peer support, individual and family counseling, and cultural competence. Additionally, the HHAP portion of the NOFA prioritizes permanent supportive housing, rapid rehousing, emergency shelter (congregate and non-congregate), street outreach, capital expenses for permanent supportive housing or enhancing existing emergency shelter projects for privacy, and lastly, operating subsidies for permanent supportive housing and rapid rehousing.
To determine priorities and opportunities for strategic application of Measure O funding in the future, department leadership plans to conduct a detailed budget and program analysis and identify areas where Measure O funding could be used and where other funding sources could be leveraged. The goal is to separate annual, recurring commitments from the projects where funding could be shifted as they mature and/or become self-sustaining.
The remaining Measure O funding would be a mix of unallocated fund balance and expected revenues. Staff plans to release a recurring Notice of Funding Availability (NOFA) for which Community Based Organizations and local government partners could apply. Through an open application process, a Community Advisory Panel will be selected to help review NOFA proposals and make recommendations to the Board for final approval. Staff will present the outlines of this proposal to the Board for further guidance and direction at the Board meeting.
Pretrial Transitional Housing and Case Management Agreement
Recommended Action:
A) Authorize the Chief Probation Officer to execute a professional services agreement with Interfaith Shelter Network, Inc. (IFSN) for the initial term December 1, 2024, through November 30, 2027, in the amount of $2,105,870, and to execute up to two one-year renewal options for a maximum five-year agreement value of $3,691,122 in addition to amendments that do not exceed $50,000 per year or otherwise substantively change agreement.
B) Authorize the Chief Probation officer to retroactively amend the current agreement expiring 11/30/24 with Interfaith Shelter Network by $135,000 for a maximum five-year value of $2,235,000.
Executive Summary:
The Probation Department requests Board approval to execute a professional services agreement with IFSN to provide services for individuals on pretrial release who are homeless and have mental illness or co-occurring mental illness and substance abuse disorder. Such individuals pose difficult challenges to the courts because while the crimes for which individuals are charged might not warrant incarceration while awaiting trial, their mental health and living conditions increase their likelihood of committing new crimes, failing to appear in court, causing harm to themselves, or being victimized in the community. To reduce these risks, courts may require such individuals to remain incarcerated until adjudication. The continuing services proposed under this agreement provide the courts a viable alternative to incarceration whereby individuals on pretrial release can remain safely in the community and receive supportive housing and intensive case management. Overall program goals are to reduce unnecessary incarceration and associated costs, provide treatment and services to improve outcomes of justice system-involved individuals, and increase public safety.
Additionally, the Probation Department requests a retroactive increase of $135,000, bringing the 5-year maximum agreement value to $2,235,000. When the contract was originally prepared in 2019, inflation was estimated to be 3 percent per year. However, the CA Consumer Price Index for All Urban Consumers has averaged 4 percent per year for the past 5 years. In addition, rent, utility, insurance, and living wage increases have contributed to the increase. These updated costs have been programmed into the agreements and contracts within the Community Corrections Partnership’s FY 24-25 budget.
The Sonoma County Community Corrections Partnership (CCP) and Measure O allocate funding for this program and have approved the FY 24-25 expenses. Future funding will depend upon continued CCP approval and Measure O funding.
Discussion:
Background
In 2016, the U.S. Department of Justice released a competitive grant for the Justice and Mental Health Collaboration Program (JMHCP). Sonoma County was awarded $250,000 for a three-year project to improve public safety and serve individuals with co-occurring mental illness and substance abuse disorder who encounter the justice system. This grant continued through September 30, 2020 and was expanded upon in 2018 with an additional $750,000 award.
In FY 21-22, upon exhaustion of JMHCP funds, Probation requested partial year funding from the CCP to continue housing and case management for mentally ill individuals on pretrial release. In FY 22-23, CCP funding was expanded to cover the full year and combined with Health Services allocation of Measure O funds for case management. The CCP and Measure O have continued to fund pretrial housing and case management, and the CCP has allocated funding for this program as part of FY 24-25 expenses. Future funding will depend upon continued CCP and Measure O approval.
Request for Proposals
The Probation Department issued a Request for Proposals (RFP) announcement in August 2024, which was distributed to 714 suppliers as well as 2,200 notifications to subscribers on Purchasing’s RFP posting list. The RFP sought proposals from organizations that could provide eight or more supportive housing beds along with case management services to individuals with mental illness on pretrial release. Additionally, the RFP requested an array of supportive services to help individuals on pretrial release stabilize their lives, such as permanent housing assistance, enrollment in health care, and job search assistance. Finally, the RFP required that the successful organization develop a quality assurance and outcome reporting plan to ensure high service standards and to help stakeholders determine program performance.
Sonoma County received proposals from IFSN and Committee on the Shelterless (COTS). A panel of representatives from the Probation Department and the Department of Health Services rated the proposals using clear criteria such as qualifications and experience, staffing, program services, and cost of service.
While both IFSN and COTS presented viable programs, the panel rated IFSN more highly based on the alignment of program services offered with the County’s needs, the ability to provide uninterrupted services, and the cost to provide services. Additionally, the COTS proposal included community-based case management only, while IFSN offers transitional housing, case management for house occupants, as well as community-based case management.
Based on its proposal review, the panel recommends awarding supportive housing and case management services to IFSN.
Program and Scope Overview
Housing: The program will provide an eight-bed housing facility, which has averaged 91 percent occupancy for the last 12 months, and support individuals with mental illness or co-occurring mental illness and substance abuse disorder maintain stability on pretrial release and achieve better outcomes. Desired outcomes include participants not committing new offenses, making their court appearances, and complying with court orders, and, post-adjudication, being better prepared to live successfully in the community. The broader goals are to enhance public safety, rehabilitate individuals in the criminal justice system, and reduce unnecessary incarceration.
Case Management: A case manager working outside the jail will support participants during the pretrial process, including accompanying them to court. This case manager will work closely with a case manager in the jail to ensure that information regarding participant needs is included in the planning process, and that those selected for the program benefit from a warm handoff and avoid service gaps. Additionally, a case manager will work on site at the supportive house to help participants connect with stabilization services, obtain medication, address health issues, and other related activities.
Quality Assurance: IFSN will collaborate with the Probation Department to develop and implement quality assurance and data collection plans to ensure high-quality program implementation and allow the Probation Department to evaluate program performance.
Conclusion
This program intends to promote public safety, improve outcomes, and reduce costs for justice-system-involved individuals with mental illness. Commonly, this population ineffectively-and expensively-accesses multiple community services, including police and fire first responders, hospital emergency departments, mental health crisis services, and jails. Most treatment is short-term and non-rehabilitative, resulting in repeated cycles through these services. By providing stable housing, intensive case management, and 24-hour monitoring, this program intends to break the cycle.
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.
Finding the Village
One of the goals of HEAPA is to research program designs dreamed up by other innovators. So when I heard that Mackenzie Scott and Jeff Bezos had collectively given $260 million to over 4,000 affordable housing and homeless service organizations, I wondered how I could learn who they were, and why they deserved the ex-couple’s support. MacKenzie had given $2 million recently to a local, very deserving organization I helped audit, and if the rest of the gifts were to similarly effective groups, I wanted to know more about them.
Fortunately, Mackenzie has chosen to help us learn. The website she created (Yield Giving) contains narratives and linked databases to $17 billion she has given away to 2,300 organizations. It provides us with her reasoning for the choices she made, and directs us to the recipients and their work. It is a treasure well worth reading.
Homeless America – Pepperdine University
On Tuesday, March 26, 2024 The Pepperdine School of Public Policy hosted “Homeless America: Creative and Compassionate Responses to a Cross-Sector Challenge” conference in downtown Los Angeles. Before COVID struck the United States in early 2020, California governor, Gavin Newsom, gave his annual “State of the State Address”, which was focused on addressing the burgeoning homelessness crisis in the state. As the impact of the virus has receded, the issue of homelessness has returned to center stage. A recent survey of Californians by the Public Policy Institute of California found that a full 89% of those questioned view homelessness as either a “Big Problem” or “Somewhat of a Problem”. The issue of homelessness draws so many policy domains from housing to mental health services and public safety. It’s also a true “cross sector” challenge, requiring engagement by the government, nonprofit, and business sectors. Through an afternoon of panels and keynotes, we explored how the public sector and nonprofit leaders are taking a variety of approaches to respond to this crisis. Keynote Address:
PANEL 1: The Role for Government MODERATOR
- Rick Cole , Adjunct Faculty, PepperdineSchool of PublicPolicy and Chief Deputy Controller ,City of Los Angeles
PANELISTS
- Kevin Faulconer, Visiting Professor of Community Leadership and Government Innovation, Pepperdine School of Public Policy
- Elizabeth Mitchell, Partner, Umhofer, Mitchell & King, LLP
- Brandon Young, Partner, Manatt, Phelps & Phillips
Keynote Address
PANEL 2: The Role for Nonprofits MODERATOR
- Soledad Ursua, Board Member, Venice Neighborhood Council
PANELISTS
- Matthew Dildine (JD ’08, MPP ’08, 04), Chief Executive Officer, Fresno Mission
- Jim Palmer, Chief Executive Officer, TrueSight Solutions
- Brian Ulf, Chief Executive Officer, SHARE!
- Byron Johnson, Distinguished Visiting Professor of Religious Studies and the Common Good,
Pepperdine Schoolof PublicPolicy
- Robert Marbut, Professor, Northwest Vista College
- Pete Peterson, Dean, Braun Family Dean’s Chair, Pepperdine School of Public Policy
Homeless Emergency Assistance Program Association 