DATE: March 11, 2025
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Agreement with Fresno County Superintendent of Schools for Specialty Mental Health Treatment and Early Intervention Services
RECOMMENDED ACTION(S):
TITLE
1. Under Administrative Policy No. 34 for competitive bids or requests for proposals (AP 34), determine that an exception to the competitive bidding requirement under AP 34 is satisfied and a suspension of competition is warranted due to unusual or extraordinary circumstances, and that the best interests of the County would be served by entering into an agreement with the Fresno County Superintendent of Schools as it is a government agency encompassing Fresno County schools in which school based specialty mental health treatment and early intervention services may be provided for the Department; and
2. Approve and authorize the Chairman to execute an Agreement with the Fresno County Superintendent of Schools, to provide specialty mental health treatment and early intervention services as part of the Fresno County’s Mental Health Services Act Community Services and Support Plan and Prevention and Early Intervention Plan, effective July 1, 2025, not to exceed five consecutive years, which includes a three-year base contract and two optional one-year extensions, total not to exceed $150,000,000.
REPORT
There is no additional Net County Costs associated with the recommended actions, which will waive the competitive bidding process and allow for continued integrated and increased access to school based specialty mental health services and early intervention services to children and youth ages 0-22 and their families. The collaboration between Fresno County Department of Behavioral Health (DBH) and Fresno County Superintendent of Schools (FCSS) has made specialty mental health services accessible in 281 school sites across school districts in Fresno County allowing increased access to those who were previously unserved or underserved. Through the continued collaboration, the goal is to continue to expand to other school sites. Services such as individual therapy, group therapy and other related mental health services will be provided in the home, hub locations, school sites and other locations throughout the community. This item is countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. Without the approval of the proposed agreement, the County cannot comply with the State approved Mental Health Services Act (MHSA) Community Services and Supports (CSS) and Prevention and Early Intervention (PEI) plans and may prevent children and youth ages 0-22 with serious emotional disturbance and their families from receiving the appropriate integrated mental health services needed to empower their well-being and recovery. If not approved, there would be a reduction in access to mental health services to over 3,500 unique persons served currently enrolled in the All 4 Youth program.
SUSPENSION OF COMPETITION/SOLE SOURCE CONTRACT:
It is requested that the County find under AP 34 that an exception to the competitive bidding requirement is satisfied, and a suspension of competition is warranted due to unusual or extraordinary circumstances, as Fresno County Superintendent of Schools (FCSS) is a government agency. FCSS acts as an umbrella government agency encompassing many of the school districts and schools within Fresno County. Securing space at school sites has been challenging and many times unsuccessful for the Department and its contracted providers. FCSS works directly with key players at each school site to secure confidential and adequate space to provide specialty mental health and early intervention services. This partnership allows the Department to meet network adequacy time and distance standards required by the California Department of Health Care Services (DHCS). The Internal Services Department - Purchasing concurs with the Department’s assessment that this satisfies the exception to the competitive bidding process required by AP 34.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. Services will be funded by MHSA PEI, CSS and Medi-Cal Federal Financial Participation. Funding amounts for specialty mental health services include MHSA - CSS funds of $4,545,135 and Medi-Cal FFP funds of $23,454,865 totaling $28,000,000 per fiscal year. Early interventions services include MHSA - PEI funding of $2,000,000 per fiscal year. Total maximum compensation for all five years is $150,000,000. Sufficient appropriations and estimated revenues will be included in the FY 2025-26 Recommended Budget for DBH Org 5630 and will be included in the future budgets for the duration of the Agreement. Funding amounts by fiscal year for specialty mental health services and early intervention services are further detailed below:
Specialty Mental Health Services:
Fiscal Year Total Contract MHSA - CSS Medi-Cal FFP
2025-26 $28,000,000 $4,545,135 $23,454,865
2026-27 $28,000,000 $4,545,135 $23,454,865
2027-28 $28,000,000 $4,545,135 $23,454,865
2028-29 $28,000,000 $4,545,135 $23,454,865
2029-30 $28,000,000 $4,545,135 $23,454,865
Maximum Compensation for all Five (5) Years: $140,000,000
Early Intervention Services:
Fiscal Year MHSA - PEI Total Contract
2025-26 $2,000,000
2026-27 $2,000,000
2027-28 $2,000,000
2028-29 $2,000,000
2029-30 $2,000,000
Maximum Compensation for all Five (5) Years: $10,000,000
The Specialty Mental Health and Early Intervention Services total maximum compensation for all five (5) fiscal years combined shall not exceed: $150,000,000.
DISCUSSION:
On June 5, 2018, the Board executed agreement No. 18-208 FCSS for the integration of specialty mental health treatment and prevention and early intervention services within the home, hub locations, at school sites and at sites throughout the community through the program commonly known as “All 4 Youth”. The agreement allowed FCSS to act as an access point to triage at-risk children and families into specialty mental health treatment within the school setting.
The program reduced barriers and increased access to specialty mental health and prevention and early intervention services by providing services at schools throughout the school districts within Fresno County. Through the program, persons served received screening, assessments and short-term treatment. Positive behavioral intervention and supports training for preschools and training in suicide preventions practices were also provided.
On June 20, 2023, the Board executed Superseding Agreement No. 23-273 with FCSS to add the DHCS California Advancing in Medi-Cal (Cal AIM) initiative requirements. Through the partnership between FCSS and the Department, the goals of expanding mental health services, increasing awareness, reducing mental health stigma through outreach and training have been met.
On March 5, 2024, the Board approved Amendment I (Agreement No. 24-098) to remove the prevention component of the Agreement due to being able to meet the goals of providing training and awareness across the schools within the County. With this amendment the program continued to offer specialty mental health and early intervention services.
The goal of the “All 4 Youth” program is to have one integrated system of care for the specialty mental health needs of persons served and their families. Through the integrated system of care, persons served will have access to individual therapy, group therapy, intensive case management, rehabilitation, medication, and other related mental health services. At the start of the program in 2018, the integrated system of care was executed at 34 school sites. In the years that followed, the following number of school sites were added:
Fiscal Year Number of Schools Number of Unique Persons Served
2018-19 34 376
2019-20 137 1676
2020-21 152 3667
2021-22 213 4436
2022-23 258 4066
2023-24 274 4320
2024-25 (as of Feb 2025) 281 3988
Currently services are provided in school sites in the Fresno metro area (Fresno Unified, Central Unified, Washington Unified), Clovis, the southwest area (Coalinga, Westside, Laton), the eastern side of the County (including Dunlap, Pine Ridge, Kings Canyon, Parlier), the westside (Mendota, Firebaugh, Kerman, Tranquility), and the south-central area (Selma, Kingsburg, Monroe, Alvina). The proposed Agreement will allow for continued collaboration and further expansion at other school sites.
Hub locations which are strategically placed to close geographic gaps in service locations throughout Fresno County are also made available to persons served. The hub locations include:
Hub Address
Selma 2020 High St., Selma, CA 93622
Fresno 2560 W. Shaw Ln. 104, Fresno, CA 93711
Eastside 4939 E. Yale, Fresno, CA 93727
The Department and FCSS have agreed to continue their partnership on the “All 4 Youth” program. The ongoing partnership between the Department and FCSS is necessary to ensure that youth continue to have access to specialty mental health and early intervention services in the home, hub locations, school sites, and throughout the community. Through the recommended Agreement, the Department and FCSS can continue to collaborate and work towards the common goal of expanding the integrated system of care model across school sites for the persons served within Fresno County.
The proposed agreement deviates from the county standard template by including mutual indemnification, modifying insurance clauses, and extending the timeframe for termination due to non-allocation of funds. The mutual indemnification is recommended because the Department and FCSS are two large agencies with the shared goals of wellness and recovery. The mutual indemnification language is needed as a sign of partnership and commitment to serve persons served in Fresno County. County Risk Management has reviewed and approved the proposed indemnification language. Additionally, the boilerplate termination language has been modified to allow for termination for Non-Allocation of Funds by the state by including a sixty (60) day notice to FCSS instead of a thirty (30) day notice. The sixty-day notice will allow FCSS time to approach their board with the termination and send notice to the affected staff.
REFERENCE MATERIAL:
BAI #27, March 5, 2024
BAI #44, June 20, 2023
BAI #9, June 5, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
Suspension of Competition
On file with Clerk - Agreement with FCSS
CAO ANALYST:
Ronald W. Alexander, Jr.