DATE: August 5, 2025
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director, Department of Behavioral Health
SUBJECT: Agreement with Pacific Clinics for a Children Continuum of Care Program
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute an Agreement with Pacific Clinics for a Children Continuum of Care program including Full-Service Partnership (FSP) for children ages 0-10 with serious emotional disturbance (SED) who qualify for Specialty Mental Health Services, and Intensive Case Management (ICM) and Outpatient (OP) levels of care for children ages 0-10 years who qualify for Specialty Mental Health Services, effective December 1, 2025, through June 30, 2030, which includes a base contract and two optional one-year extensions, total not to exceed $22,657,420.
REPORT
There is no Net County Cost associated with the recommended action. Approval of the recommended action would allow Pacific Clinics to provide specialty mental health services to children ages 0-10 years of age through the Children Continuum of Care program and ensure Fresno County Department of Behavioral Health meets mandated network adequacy time and distance standards and Mental Health Services Act (MHSA) requirements as set by the Department of Health Care Services (DHCS). The proposed agreement would be funded by MHSA Community Systems and Supports (MHSA-CSS) funds and Medi-Cal Federal and State funds with no Net County Cost. This item is countywide.
ALTERNATIVE ACTION(S):
There are no alternative actions. Should the recommended action not be approved, mental health services for high acuity children and their families would be eliminated, which would impact compliance with network adequacy time and distance requirements, and MHSA requirements set by the DHCS.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The recommended agreement will be funded with MHSA-CSS and Medi-Cal Federal Financial Participation (FFP) funds in the amounts of $22,657,420. Sufficient appropriations and estimated revenues are included in DBH’s Org 5630 FY 2025-2026 Recommended Budget and will be included in subsequent budget requests for the duration of the term of the Agreement. Actual costs will be determined by actual services provided.
DISCUSSION:
On July 10, 2018, the Board of Supervisors approved to enter into Agreement No. A-18-366 for the continued provision of Bright Beginnings for Families, mental health and community supports for youth and their families. The agreement was amended once to increase the maximum compensation to help the provider reduce high staff turnover rates by increasing wages.
On August 9, 2022, the Board approved Superseding Agreement No. A-22-342 to allow the County to continue the contract following an agency merger resulting in a name change for Pacific Clinics, formerly known as Uplift Family Services.
On June 20, 2023, the Board approved Superseding Agreement No. A-23-276 to include new California Advancing and innovating Medi-Cal (CalAIM) requirements set by the Department of Health Care Services (DHCS) including payment reform requirements. The Superseding Agreement also extended the Agreement term for two additional years. The Agreement was amended once to add Intensive Case Management and Outpatient levels of care to allow children to transition to a lower level of care with minimal disruption to services.
On June 24, 2025, your Board approved Amendment No. 2 (No. 25-287) to the Agreement to extend the term for three months, with an optional additional three-month extension, to prevent a gap in services in anticipation of the implementation of a new Agreement.
The Department released a Request for Proposals (RFP) on March 18, 2025, for the provision of a Children Continuum of Care program including, FSP for children ages 0-10 years with serious emotional disturbances who qualify for specialty mental health services, and ICM and OP mental health services for children ages 0-10 who qualify for Specialty Mental Health Services. Addendum No. 1 to the RFP, published on April 3, 2025, Addendum No. 2 to the RFP, published on April 9, 2025, and Addendum No.3. to the RFP, published on April 11, 2025, were released to respond to potential bidder questions and update reimbursement rates for the new fiscal year. Six bids were received: Victor Community Support Services, Inc. ($31,665,417), Pacific Clinics ($24,605,334), Central Star Behavioral Health, Inc. ($35,065,192), Hope and Healing Family Therapy Center ($39,055,383), Exceptional Parents Unlimited, Inc. ($25,965,472), and Comprehensive Youth Services of Fresno, Inc ($4,564,347). An evaluation panel reviewed all bids and recommended entering into an Agreement with Pacific Clinics.
Pacific Clinics was selected as the best fit for the County’s needs. The bid included a detailed plan for the use of Community Supports and Services funding, reflecting their understanding of the “whatever it takes” model of care. Pacific Clinics has extensive experience and has proposed a field-based program that also reflects a clear understanding of the required 24/7 access component, which will be operated by their leadership team. Pacific Clinics demonstrated a clear understanding of the needs of the target population, through their proposed office hours, staffing plan which included internal medication services, their extensive training on FSP principles and practices, and their collaborative relationships with a wide variety of community resources (other mental health providers, Central Valley Regional Center, the schools, food banks, and legal services.
Under the MHSA, also known as Proposition 63, county behavioral health departments receive funding to assist in providing services to underserved and unserved populations. Following a mandated local community stakeholder process to identify the highest service needs of the county, MHSA-CSS funds were allocated by the department to provide FSP services for children ages 0-10 who have SED.
The recommended Children Continuum of Care agreement would serve children ages 0-10. In addition, siblings, relatives, caregivers, and other significant support persons of the FSP enrolled person served, may receive specialty mental health services through this program.
FSP services encompass a unified team approach, in which the provider commits to do “whatever-it-takes” to assist the person served in reaching their recovery, resiliency, and wellness goals and reduce the number of days of hospitalization, and juvenile justice involvement. Persons served at this level meet the State-defined FSP criteria and require higher intensity services to meet their needs. This level of care has an increased focus on engagement, collaboration with the person served/family and stabilization to achieve mutually agreed upon treatment goals. These services are accessible 24 hours per day, 7 days per week via a support line where a staff member known to the family is available by phone. Persons served are provided three contacts per week with at least one being face to face.
ICM provides persons served with regularly scheduled case management, individual rehabilitation and/or individual therapy. These services are accessible during standard office hours. Persons served are provided one or two contacts per week with at least one being face to face. OP provides persons served with therapeutic appointments for individual/group treatment, case management, and medication services, as needed. These services are accessible during standard office hours. Persons served are provided at least one contact per week, with at least one of those contacts being face to face each month.
Services under the recommended agreement will be offered in the office, at home, within the community, as preferred by the person served and their guardian, and will include, assessment, care planning/goal setting, psychiatry/medication support, individual/family therapy, group therapy, targeted case management, peer support services, rehabilitation, intensive care coordination, intensive home-based services, and linkage to additional services and support. Evidence Based Practice models recognized as effective in improving functioning of the target population will be utilized in the programs. These models include and are not limited to; Dialectical Behavior Therapy, Trauma Informed Care, Trauma-Focused Cognitive Behavioral Therapy, Motivational Interviewing, and Eye Movement Desensitization and Reprocessing.
The maximum compensation for the agreement was calculated by using historical data from Fiscal Years 2023-2024 and 2024-2025, staffing, and Fee-For-Service reimbursement rates. Through the current agreement, 441 persons served were served in Fiscal Year 2023-24 at a cost of $3,392,342 and 488 persons served were served in Fiscal Year 2024-2025 at a projected cost of $1,976,925. The maximum compensation for Fiscal Year 2025-26 has been prorated to account for funds budgeted to the 3-month extension of the current agreement.
Approval of the recommended action will execute the Agreement with Pacific Clinics for the provision of Children Continuum of Care services, for a five-year term, total not to exceed $22,657,420.
The modification and budget modification clauses of the agreement delegate the Board’s authority to the DBH Director to make non-material changes to the agreement, that will not result in any change to the maximum compensation payable to the Contractor, during the term of the agreement, as further described in Article 15, Sections 1 and 2 of the agreement.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was notified of this agreement at the July 2025 Meeting.
REFERENCE MATERIAL:
BAI #51, June 24, 2025
BAI #23, February 20, 2024
BAI #44, June 20, 2023
BAI #33, August 9, 2022
BAI #27, June 8, 2021
BAI #30, December 11, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with Pacific Clinics
CAO ANALYST:
Ronald W. Alexander Jr.