DATE: August 6, 2024
TO: Board of Supervisors
SUBMITTED BY: Sanja Bugay, Director, Department of Social Services
Susan Holt, Director, Department of Behavioral Health
Kirk Haynes, Chief Probation Officer, Department of Probation
SUBJECT: Children’s Crisis Continuum Pilot Program Grant Application and Retroactive Standard Agreement for the Children’s Crisis Continuum Pilot Program
RECOMMENDED ACTION(S):
TITLE
1. Retroactively approve and authorize the Department of Social Services’ previous submittal of a grant application to the California Department of Social Services for the Children’s Crisis Continuum Pilot Program ($8,500,000); and
2. Approve and authorize the Chairman to execute a retroactive Standard Agreement with California Department of Social Services for the Children’s Crisis Continuum Pilot Program effective July 1, 2023, not to exceed five consecutive years, total not to exceed $8,500,000.
REPORT
There is no additional Net County cost associated with the recommended actions, which will allow the County to participate in the California Department of Social Services (CDSS) and the Department of Health Care Services (DHCS) Children’s Crisis Continuum Pilot program. This effort seeks to build infrastructure to meet the placement and therapeutic needs of high needs foster youth. The proposed project will involve close collaboration with the Departments of Behavioral Health and Probation. To meet the State’s requirements, the Department of Social Services is designated as the lead administrative entity for the application and project implementation.
It should be noted that the State published a Request for Proposal (RFP) on July 13, 2022. To meet the grant application deadline of December 1, 2022, an application was submitted on December 1, 2022, contingent upon the Board’s approval. The State sent tentative approval of funding on February 24, 2023. A “Final Work Plan and Budget” were required and submitted to the State on April 28, 2023.Following subsequent discussions with the State, revised versions of the Final Work Plan and Budget were submitted on September 13, 2023, October 19, 2023, and May 31, 2024. Due to Madera County withdrawing from participation in the pilot program, an additional version was required and submitted on June 18, 2024. On June 20, 2024, this Standard Agreement was received from the State to be approved and signed by your Board. This item is Countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, the application for the Children’s Crisis Continuum Pilot Program will be rescinded and the County will forego the opportunity to receive up to $8.5 million in funding to improve enhanced treatment and placement options for foster youth with complex needs across Fresno County.
RETROACTIVE AGREEMENT:
The Standard Agreement is retroactive to July 1, 2023, which is the date the funds first became available to the grant recipients. However, due to multiple rounds of revisions of the Final Work Plan and Budget between CDSS and the County, including one resulting from Madera County withdrawing their participation in the pilot program, the finalized version of this Standard Agreement was not received from the State until June 20, 2024. Subsequent time for processing delayed this item from being placed on an earlier Board date.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The recommended agreement will provide a maximum of $8,500,000 for project implementation through June 30, 2028. Sufficient appropriations and estimated revenues will be included in the Department of Social Services Org 5610 FY 2024-25 Recommended Budget and will be included in subsequent budget requests. In addition to this grant, the development and implementation of the Pilot Program will also be supported by the awarded Complex Care Capacity Building allocation (startup funds for EE-ISFC, CCRP, and E-STRTP), Title IV-E funds (Innovative Model of Care rates), Medi-Cal revenue, SB 163, and 2011 Realignment.
DISCUSSION:
In July 2021, Assembly Bill (AB) 153 (Chapter 86, Statutes of 2021) was signed into law, mandating the creation of the Children’s Crisis Continuum Pilot Program (CCCPP) to be jointly implemented by CDSS and DHCS. The pilot program is intended to provide a framework for a highly integrated Continuum of Care for foster youth with high acuity needs across California. The purpose is to address perceived gaps in services and placements within the Continuum of Care in order to ensure that the complex behavioral, developmental, and physical needs of these foster youth are better met. The intention is to eliminate these gaps by fully integrating the System of Care (SOC) by providing stabilization and treatment for foster youth in crisis who require short-term intensive stabilization in a trauma-focused residential treatment setting coupled with ongoing, timely, and seamless transition support between levels of care in the least restrictive setting possible.
On July 13, 2022, the State released a Request for Proposal (RFP) seeking pilot counties to develop and implement a crisis Continuum of Care for this population. Fresno County, in addition to other counties statewide, has been challenged with providing high-needs foster youth with family-based placements and effective, intensive, trauma-informed services to stabilize and meet their needs. For these youth in crisis, many have been compelled to stay overnight in County offices or in hospital emergency departments. Currently, the Department of Social Services is engaged with the State’s Community Care Licensing division to license a facility as a transitional shelter, and many of the same youth are admitted there. Concurrently, the Department is developing other strategies that, if successful, will ultimately result in a decreased need for the transitional shelter and/or its closure. This effort is consistent with Department strategies and will positively impact the care of foster youth.
At the time of application for the grant, Fresno and Madera Counties were working together as a regional collaborative. On May 30, 2024, Fresno County received notice that Madera was withdrawing from participation in the collaborative, citing concerns regarding projected program costs and state allocations. Following the submission of a revised Work Plan and Budget on June 18, 2024, CDSS has agreed to let Fresno County absorb Madera’s 10% allocation ($850,000), totaling $8,500,000 for Fresno County.
The Departments of Social Services (DSS), Behavioral Health (DBH), and Probation currently maintain a collaborative relationship in the development and implementation of the pilot program. The County already has significant pieces in place to implement and sustain a successful Crisis Continuum of Care program, such as existing facilities and service provision contracts with numerous community-based organizations; however, additional resources and partners are necessary to coordinate a robust and effective pilot. Therefore, Fresno County is committed to leveraging existing facilities, contracts, and partnerships to build and sustain a responsive Children’s Crisis Continuum program that supports the safety and well-being of the region’s foster youth with high acuity needs.
The proposed Children’s Crisis Continuum Pilot Program addresses the County’s needs by introducing the missing crisis services in combination with a fully integrated care management structure. The Children’s Crisis Residential Program (CCRP), Enhanced Intensive Services Foster Care (E-ISFC) homes, and Emergency Enhanced Services Foster Care (EE-ISFC) homes provide intensive, individualized supports in licensed facilities for youth not requiring treatment in locked, inpatient facilities but who are not yet ready to transition down to lower levels of care such as ISFC homes or Short Term Residential Treatment Programs (STRTP). Further, by introducing intensive Wraparound services (“Super Wraparound”) through Core Teams, youth and families will receive a single point of care management, ensuring seamless service delivery that will follow them throughout the service continuum. These Core Teams will be comprised of clinicians, counselors, and peer support available to provide 24/7 rapid response to urgent needs, community-based support, therapeutic behavioral services, crisis intervention, permanency support, stabilization of behavioral health needs, and prevention of repeated hospitalizations. This model is intended to lessen the reliance on law enforcement, further engages the youth with their natural network of support, and provides continuity of care that lessens the demand on young people as they move through the Crisis Continuum.
This agreement differs from the County’s model contract in that it includes one-way indemnification in favor of the State. This has the effect of relieving the State of any responsibility for any losses to any grantees, subgrantees, or vendors arising from their own negligent or wrongful performance, or failure to perform, as well as from the County’s negligent or wrongful performance, or failure to perform. The one-way indemnification clause has been reviewed by Risk Management and deemed to be acceptable for this agreement between public entities.
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Application for Children’s Crisis Continuum Pilot Program
On file with Clerk - Standard Agreement with CDSS
CAO ANALYST:
Ronald Alexander