DATE: June 5, 2018
TO: Board of Supervisors
SUBMITTED BY: Dawan Utecht, Director, Department of Behavioral Health
SUBJECT: Fresno County Superintendent of Schools - Specialty Mental Health Treatment and Prevention and Early Intervention Services Agreement
RECOMMENDED ACTION(S):
TITLE
1. Make a finding that is in the best interest of the County to waive the competitive bidding process consistent with Administrative Policy No. 34 for unusual or extraordinary circumstances for school based specialty mental health treatment and prevention and early intervention services for the Department of Behavioral Health; 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 prevention and early intervention services as part of the Fresno County’s Mental Health Services Act Community Services and Supports Plan and Prevention and Early Intervention Plan, effective July 1, 2018, not to exceed five consecutive years, which includes a three-year base contract and two optional one-year extensions, total not to exceed $111,210,977.
3. Approve and authorize the Department of Behavioral Health Director or designee, to add/delete school sites to the proposed Agreement to meet the needs of the community, without exceeding the contract fiscal year compensation amount.
REPORT
Approval of the recommended actions will waive the competitive bidding process and allow for an expanded integrated school based treatment and prevention and early intervention program at various Fresno County school districts for pre-school through 12th Grade children and families. This unique collaboration between Fresno County Department of Behavioral Health (DBH) and Fresno County Superintendent of Schools (FCSS) for the innovative expansion and implementation of integrated school based mental health programs and services will allow participating schools to serve youth and families in a strength based model and will extend serves to clients currently not being served. The DBH Director or designee will have the authority to add/delete school sites to the agreement as necessary to meet the needs of the underserved and un-served target youth and their families without exceeding the maximum annual amount. These programs are Mental Health Services Act (MHSA), and Medi-Cal funded with no increase in Net County Cost. The proposed Agreement contains language that includes the provision to allow the DBH Director, or designee, to authorize budget line item and expense category changes that do not exceed ten percent (10%) of the total contract amount.
ALTERNATIVE ACTION(S):
There is no viable alternative action. Without the approval of the proposed agreement, the County cannot comply with the State approved MHSA Community Services and Supports (CSS) and Prevention and Early Intervention (PEI) plans and may prevent school aged youth and their families from receiving the appropriate integrated mental health services needed to empower their well-being and recovery.
SUSPENSION OF COMPETITION/SOLE SOURCE CONTRACT:
The Department’s request to suspend the competitive bidding process is consistent with Administrative Policy No. 34 as FCSS is a government agency. FCSS acts as an umbrella government agency encompassing many of the school districts and schools within Fresno County. The Internal Services Department - Purchasing concurs with the Department’s request to suspend the competitive bidding process.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions as services are fully funded by MHSA and Medi-Cal. Sufficient appropriations and estimated revenues will be included in the FY 2018-19 Recommended Budget for DBH Org 5630 and will be included in the future budgets to cover the total anticipated cost of the contract terms. The FCSS anticipates over 200 participant school programs to be funded through this collaborative effort for a FY 2018-19 maximum of $7,808,086. FCSS shall use AB 114 in-kind funds for services that provide Educationally Related Mental Health Services (ERMHS), which includes classes for students who have severe social emotional behavioral needs. FCSS shall only be compensated for actual expenditures incurred. Funding amounts by fiscal year for specialty mental health services and prevention and early intervention services are further detailed below:
Specialty Mental Health Services:
Fiscal Year Total Contract MHSA Ramp CSS Medi-Cal FFP
2018-19 $6,220,264 $2,057,193 $1,248,879 $2,914,192
2019-20 $13,709,938 $787,930 $3,757,205 $9,164,804
2020-21 $18,227,020 $667,271 $5,227,637 $12,332,112
2021-22 $23,027,015 $709,834 $6,924,876 $15,392,304
2022-23 $28,567,809 $646,147 $8,753,716 $19,167,946
Maximum Compensation All Five (5) Years: $89,752,046
Prevention and Early Intervention Services:
Fiscal Year Contract Maximum (MHSA PEI Funds)
2018-19 $1,587,822
2019-20 $3,290,230
2020-21 $4,352,581
2021-22 $5,448,649
2022-23 $6,779,650
Maximum Compensation All Five (5) Years: $21,458,932
Total maximum compensation for entire five-year term for specialty mental health services and prevention and early intervention services combined shall not exceed $111,210,977.
DISCUSSION:
On May 21, 2013, your Board approved an agreement with various School districts (including Fresno Unified, Clovis Unified, Central Unified, Selma Unified and various others) for MHSA CSS mental health treatment services being provided at various school sites. On June 2, 2015, your Board approved an agreement with Fresno County office of Education to provide MHSA PEI programs at K-12th Grade school sites. On December 5, 2017, your Board approved DBH’s MHSA FY 2016-17 Annual Plan Update and Three Year Plan Update, which included funding for the expansion of PEI and CSS programs.
The goal of this integrated expanded treatment program (commonly referred as the “All 4 Youth Program”) is to provide one school based integrated system of care for behavioral health service needs of youth and families. Services will include individual therapy, group therapy, intensive case management, rehabilitation, medication, and other related mental health services. Specialty mental health treatment services will be available to seriously emotionally disturbed (SED) youth. Services will be provided at the schools, preschools, homes and community based settings as needed. This proposed agreement allows for the gradual periodic expansion of services to various geographical school sites (hubs), with the intent to add around the main hubs, other satellite school locations. Satellite sites can be expanded to include additional services as determined by client needs. Through this joint collaboration, FCSS shall eventually allocate clinical staffing to all school sites in the County. Geographical hubs will be placed strategically to provide coverage in all areas of Fresno County. By phase 5 (year 5 of the proposed agreement) coverage shall be provided 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 west side (Mendota, Firebaugh, Kerman, Tranquility), and the south central (Selma, Kingsburg, Monroe, Alvina). Any new schools or sites may be added throughout the duration of this proposed agreement by the Director of DBH, or designee.
The goal of the PEI integrated expanded program is to provide for positive behavioral intervention and supports in a school setting. The purpose of the PEI component is to reduce the long-term adverse impact on individuals and their families resulting from untreated mental illness. Positive Behavioral Interventions and Supports (PBIS) is a proven approach to early identification and prevention of behavioral and/or emotional problems. The prevention framework allows youth early access to evidence-based academic and behavioral practices prior to the onset of severe behavior and/or emotional challenges. Since the inception of the MHSA funded PBIS program, 138 schools have been trained in PBIS. The adoption of a PBIS framework within the schools has had a positive effect on decreasing problem behaviors, increasing school attendance, and improving school climate. Schools organize their continuum of practices and interventions in a multi-tiered logic model. The tiers typically include a universal level (e.g., all students receive preventative services), a targeted level (e.g., students requiring more early interventions in addition to the school-wide or universal practices), and a tertiary or linkage level (e.g., students requiring individual and intensive level of supports). In general, school based programs will incorporate positive behavioral PEI services reflecting evidence-based models which must include the three-tiered integrated approach. This structure is designed to mitigate school failure and juvenile justice involvement by addressing school issues such as positive school behavior, bullying, stigma, poor social skills and other problems that are in the early stages and thus affect the child’s overall mental well-being. PBIS services have been included within 23 school districts serving over 66,000 students. This program has shown a 73% - 100% reduction in student suspensions/expulsions at various schools. Approximately 75% of the schools have reported an improvement in protective factors based on school safety surveys.
The proposed new agreement will expand mental health treatment and PEI services by adding the following key components:
• Trauma informed practices in the current PBIS schools
• PBIS training for preschools
• PEI screening and assessment and short-term treatment
• Training in suicide prevention practices
• Perinatal wellness and prevention strategies to increase mental health services to this population (0-5 years of age)
• Integration of mental health treatment staffing into the school-wide system
• Act as an access point to triage at-risk children and families into specialty mental health treatment services at the school setting
• Reducing barriers to access, by providing services to many more schools
• One Continuum of care for treatment and PEI to many more schools
• Seamless system of care that promotes a positive healthy environment
The proposed agreement contains language that includes the provision to allow the DBH Director, or designee, to authorize budget line item and expense category changes that do not exceed ten percent (10%) of the total contract amount; and to approve the addition/deletion of school sites. The proposed agreement allows for a deviation of the standard County boilerplate language for termination of the agreement by the County in the event of non-allocation of funding by the State by including a 60 day notice to FCSS instead of a 30 day notice. Section 11 of the agreement contains the insurance coverage and language currently approved for use in the County’s model contract. Risk Management has recently proposed that the insurance coverage and language in the County’s model contract be revised. County Counsel and Risk Management will be working on these changes over the next several months. However, the Department has a need to move forward with this contract to address service needs. Additionally, the Department believes the insurance coverage required in Section 11 of the agreement adequately protects the interests of the County in this contract and County Counsel is comfortable signing the agreement as to legal form. Therefore, it is recommended your Board approve the recommended agreement in its current form. Upon approval by your Board, the recommended actions would be effective July 1, 2018 through June 30, 2021 with two optional one-year extensions based on satisfactory outcome performance measures. The recommended actions will not result in any lay-offs of DBH staff. Over the next several years, as FCSS expands it services to other school sites where County staff maybe present, DBH staff shall be re-purposed to provide services at other areas/facilities as needed to meet the needs of the Department.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was informed of the recommended agreement at its April 18, 2018 meeting.
REFERENCE MATERIAL:
BAI #5, December 5, 2017 - MHSA FY 2016-17 Annual Update and Three Year Plan Update
BAI #26, June 2, 2015 - Agreement for PEI K-12 Services
BAI #48, May 21, 2013 - Agreement for Mental Health Treatment Services
ATTACHMENTS INCLUDED AND/OR ON FILE:
PD-048 - Suspension of Competition
On file with Clerk - Agreement, including all Exhibits
CAO ANALYST:
Ronald W. Alexander, Jr