DATE: June 21, 2022
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Rural Crisis Intervention Team Services
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute an Agreement with Kings View for Crisis Intervention Team services in the rural areas of Fresno County, effective July 1, 2022, not to exceed three consecutive years, which includes a two-year base contract with one optional one-year extension, total not to exceed $8,546,926.
REPORT
Approval of the recommended action will allow Kings View to operate a Crisis Intervention Team (CIT) program for individuals in the rural areas of the County experiencing a behavioral health crisis. Costs will be funded with Mental Health Services Act Prevention and Early Intervention (MHSA-PEI) and Medi-Cal Federal Financial Participation (FFP), with no Net County Cost. This item is countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. If your Board does not approve the recommended action, the County will not be able to provide necessary community-based crisis services to individuals experiencing a behavioral health crisis in rural communities.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The maximum compensation will not exceed $8,546,926 and will be funded with MHSA-PEI and Medi-Cal FFP. Sufficient appropriations and estimated revenues will be included in the Department’s Org 5630 FY 2022-23 Recommended Budget and in future budget requests for the term’s duration.
DISCUSSION:
The Rural CIT (formerly Rural Triage Mental Health) provides behavioral health services in the rural community of the County. These services were originally established using Senate Bill 82: Investment in Mental Health Wellness Act (Chapter 34, Statutes of 2013) grant, Public Safety Realignment, Medi-Cal FFP revenue, and MHSA-PEI funds, with no Net County Cost. These services resulted from the MHSA community stakeholder process, which recognized the need to provide CIT services to individuals experiencing a behavioral health crisis in the rural areas of the County.
Rural CIT is comprised of behavioral health clinicians who respond with law enforcement and other first responders to 9-1-1 calls for service involving individuals within rural areas of the County who are experiencing a behavioral health crisis. Clinicians are dispatched to the scene with law enforcement, which allows patrol officers to address other incoming emergency calls if the crisis situation is more appropriately addressed by the clinicians. Clinicians respond to the initial crisis, but also provide post-crisis case management activities, referrals, and linkage to appropriate services. Services provided by the CIT include crisis assessments, suicide risk assessments, safety plan development, disseminating information regarding behavioral health services and community resources, and provide follow-up case management and care coordination activities to link the individual to appropriate services. CIT services are culturally responsive, strengths-based, trauma-informed, and recovery-oriented.
In FY 2020-21, the Rural CIT program served 1,685 individuals experiencing a behavioral health crisis in rural Fresno County. Of these individuals, approximately 46% stabilized during their contact with Rural CIT program clinicians and did not require hospitalization. The cost per person served on average is $1,642.
The current contract for Rural CIT services operated by Kings View will terminate on June 30, 2022.
On March 9, 2022, the Department, in coordination with the Internal Services Department - Purchasing Division, issued Request for Proposal (RFP) #22-050 for Rural CIT services, which closed on April 4, 2022 with one response submitted. The RFP evaluation committee met on April 22, 2022, to review the proposal submitted by Kings View. The committee was comprised of Staff Analysts from the Departments of Behavioral Health, Social Services and Public Health. Kings View’s proposal was evaluated based on the Scope of Work, Cost Proposal and other miscellaneous requirements stated in the RFP. The committee unanimously agreed King View’s proposal met the requirements and needs of the County, and recommended awarding the agreement to Kings View.
Upon your Board’s approval, the recommended agreement will result in no service disruption or need for transition of persons served. Additionally, all necessary site certification and staff acquisition is already in place.
On October 19, 2021, your Board approved and authorized the Department to submit a grant application to the Department of Health Care Services (DHCS) for supplemental funds to expand crisis services through a Crisis Care Mobile Unit (CCMU) grant opportunity. A portion of the funding was included in the Rural CIT RFP and Kings View’s RFP response; however, the funding was removed from the recommended agreement due to pending contract negotiations between the County and DHCS’ grant administrator, Advocates for Human Potential, Inc. Upon receipt of the CCMU grant agreement, an amendment to the Rural CIT agreement will be brought back to your Board for approval.
The recommended agreement allows the Department Director, or designee, to approve changes to line items within the budget that do not exceed 10% of the line item maximum and do not result in any change to the term’s maximum compensation amount. Also, the recommended agreement includes language for termination by Kings View, the County, or their designees upon the giving of 60 days advance written notice. Additional language included allows for the termination of the agreement due to non-allocation of funds upon the giving of 30 days advance written notice to Kings View. The recommended agreement term deviates from the County’s standard agreement term, from five to three years, due to the Department’s ongoing efforts to combine the Rural CIT with Metro CIT under a Master Agreement. Metro CIT Agreement No. 18-688 approved by the Board on December 11, 2018, expires June 30, 2023, and the Department intends to release another RFP in 2022 to achieve its goal.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board will be notified of the recommended agreement during the June 15, 2022 meeting.
REFERENCE MATERIAL:
BAI #25, October 19, 2021
BAI #37, June 22, 2021
BAI #31.1, April 28, 2020
BAI #32, December 11, 2018
BAI #47, July 10, 2018
BAI #35, July 14, 2015
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with Kings View
CAO ANALYST:
Sonia M. De La Rosa