DATE: April 13, 2021
TO: Board of Supervisors
SUBMITTED BY: Dawan Utecht, Director, Department of Behavioral Health
Delfino E. Neira, Director, Department of Social Services
SUBJECT: Amendment to Master Agreement No. 19-277 for Child Welfare Mental Health Services
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute Amendment I to Master Agreement No. 19-277 with providers of Child Welfare Mental Health Services for individuals in the Child Welfare Services System to address the increased number of referrals, effective upon execution with no change in term from July 1, 2019 through June 30, 2024 and increasing the maximum by $27,000,000 to a total of $107,000,000.
REPORT
Approval of the recommended action will allow for an increase to the maximum compensation amounts for FY 2020-21 and the remaining fiscal years of the agreement. This change is necessary to ensure quality mental health services are provided to children and families involved with the Department of Social Services’ (DSS) Child Welfare Services system, in compliance with Katie A. Settlement Agreement (Katie A.) mandates. The recommended increase in compensation will be primarily offset by Medi-Cal Federal Financial Participation (FFP) and Mental Health Realignment revenues, with no increase in Net County Cost. This item is countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. Should your Board not approve the recommended action, children and families involved in the DSS Child Welfare Services system who are currently receiving court-ordered specialty mental health services and/or requiring services in the future may experience a gap and/or delay in services.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The recommended action will increase the total maximum compensation amount by $3,000,000 for FY 2020-21, $7,500,000 for FY 2021-22, $8,000,000 for FY 2022-23, and $8,500,000 for FY 2023-24. The combined total of the increases equal $27,000,000. The total maximum amount compensation amount of the amended Master Agreement ($107,000,000) will be fully offset with Medi-Cal FFP, Mental Health Realignment, and 2011 Child Welfare Realignment. Sufficient appropriations and estimated revenues are included in the Behavioral Health Org 5630 and DSS Org 5610 FY 2020-21 Adopted Budgets and will be included in subsequent budget requests for the entirety of the contract term.
DISCUSSION:
The Department of Behavioral Health (DBH) and DSS have worked towards the provision of specialty mental health services for children and their families involved in the DSS Child Welfare Services system. The goal of this collaboration is to effectively monitor contracts with community-based providers to ensure the program meets the mental health needs of this population, consistent with State-mandated Katie A. requirements, now known as the Pathways to Mental Health Core Practice Model, and the California Integrated Core Practice Model.
On June 18, 2019, your Board executed Master Agreement No. 19-277 for outpatient specialty mental health and court-specific services to children and families involved in the DSS Child Welfare Services system. Three agencies, California Psychological Institute (CPI), Central Star Behavioral Health (Central Star), and Uplift Family Services (Uplift), were included in the executed Master Agreement. All three agencies were chosen from Request for Proposal (RFP) 19-036: Child Welfare Mental Health Services, as they were considered the most responsive and advantageous to the County.
In FY 2019-20, the program experienced an overall increase of 15% (or 395) in the number of referrals received from DSS. This increase was attributed to an increase in the number of children entering foster care and the Departments anticipate this trend may continue. This increase in referrals impacted the caseloads experienced by each agency, contributed to unexpected employee turnover and delays in timeliness of service, and could eventually impact the quality of care provided to youth and their families. The majority of the clients served have high-acuity needs and require long-term services. In FY 2018-19, there were a total of 2,634 referrals made to three vendors, with 3,224 unique clients served and 68,207 services rendered. In FY 2019-20, there were a total of 3,029 referrals made to three vendors, with 3,355 unique clients served and 71,621 services rendered. In the first six months of FY 2020-21, there have been 1,049 referrals, 2,077 unique clients served, and 33,535 services rendered.
With the increase in referrals and its impact to the current agencies, as well as the high-acuity needs of the clients, it became apparent that a fourth agency would need to be added to the Master Agreement to help reduce the caseload size and aide in increasing service capacity. The Departments reached out to Turning Point of Central California (Turning Point), the fourth bidder from RFP 19-036. After discussion with Turning Point, it was determined that their addition to the Master Agreement would help meet the needs of the program. Additionally, the three current vendors identified a need to increase salaries in order to remain competitive and support staff retention. These changes aligned with a salary study conducted by DBH and were approved. It was also determined that the contract maximum of the overall Master Agreement would need to be increased to accommodate both changes.
The recommended amendment would ensure the necessary budget and capacity for the Child Welfare Mental Health Services providers to continue to meet the needs for youth and their families, without a gap or delay in services.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was informed of the recommended amendment at its January 20, 2021 Board Meeting.
REFERENCE MATERIAL:
BAI #39, June 18, 2019
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment I to Master Agt. No. 19-277
CAO ANALYST:
Sonia M. De La Rosa