DATE: August 22, 2023
TO: Board of Supervisors
SUBMITTED BY: Susan L. Holt, Director of Behavioral Health
SUBJECT: Resolution to Approve Agreement No. CY FRES-01 for the Investment in Mental Health Wellness Grant Program for Children and Youth
RECOMMENDED ACTION(S):
TITLE
1. Adopt resolution to approve retroactive Agreement No. CY FRES-01 as required by the California Health Facilities Financing Authority (CHFFA), which includes authorizing the Director of the Department of Behavioral Health, or designee to execute associated agreement documents, exhibits, certifications and reports that otherwise do not increase or modify the agreement; and
2. Approve and authorize the Chairman to execute retroactive agreement with CHFFA for the Investment in Mental Health Wellness Grant Program for Children and Youth effective December 1, 2022 through July 31, 2024, total not to exceed $1,371,806.
REPORT
Approval of the first recommended action will adopt a resolution consistent with California Health Facilities Financing Authority (CHFFA) guidelines for the grant agreement. Grant funding will enhance the Crisis Intervention Team (CIT) services for youth in Fresno County. This action includes approving the Department of Behavioral Health Director or designee to submit required grant items and reports on behalf of the County, and authorize minor budget modifications, as needed. This item is countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. If your Board does not approve the recommended actions, the County would not be able utilize the CHFFA grant funds to expand CIT services and resources for youth.
RETROACTIVE AGREEMENT:
The recommended revenue Agreement with CHFFA is retroactive to December 1, 2022 to align with the funding term set up by CHFFA. The Department received the final agreement from CHFFA via electronic mail on December 22, 2022. The period to prepare, review, and negotiate the agreement and associated program service amendments to be funded by the Investment in Mental Health Wellness Grant did not allow presentation to the Board on an earlier date.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The grant award will provide $1,371,806 for CIT services and resources within the grant period beginning December 1, 2022, and ending on July 31, 2024. The funding includes $784,824 for Personnel and $586,982 for Capital expenses, including a three-month ramp-up period. There is no County match requirement for receipt of grant funds. The Department will return to your Board with amendments to the existing CIT service agreements (Agreement No.s 23-308 and 23-303) to add funding for the proposed program. Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2023-24 Recommended Budget and will be included in future budget requests for the term’s duration.
DISCUSSION:
In 2013, Senate Bill 82, the Investment in Mental Health Wellness Act of 2013, established a competitive grant program to disburse funds to California counties or to their nonprofit or public agency designees for the purpose of developing mental health crisis support programs. Specifically, funds were to increase capacity for client assistance and services in crisis intervention, crisis stabilization, crisis residential treatment, rehabilitative mental health services, and mobile crisis support teams and supported capital improvement, expansion and limited start-up costs.
In 2016, Senate Bill 833 (Section 20) expanded the Investment in Mental Health Wellness Act to specifically address a continuum of crisis services for children and youth, 21 years of age and under. Funding was to be allocated to develop crisis residential treatment, crisis stabilization, mobile crisis support teams, and family respite care programs for this specific population. As before, grants from CHFFA are to be disbursed to California counties or to their nonprofit or public agency designees to support capital improvement, expansion and limited start-up costs.
On June 21, 2022, the Board approved Agreement No. 22-266 with Kings View for Rural CIT services. Services include, but are not limited to: assessment, crisis intervention, community referrals and linkages, and short-term case management. On September 20, 2022, the Board approved Superseding Agreement No. 22-422 to add Crisis Care Mobile Units grant funding and allow DBH to host CIT for Youth training events. On June 20, 2023, the Board approved Supersede Agreement No. 23-308 to add Department of Health Care Services (DHCS) California Advancing and Innovating Medi-Cal (CalAIM) language. This agreement has been funded with Senate Bill (SB) 82 Investment in Mental Health Wellness Act of 2013 grant, Public Safety Realignment, Mental Health Services Act (MHSA) Prevention and Early Intervention (PEI) and Medi-Cal Federal Financial Participation (FFP) revenue.
On December 11, 2018, the Board approved Agreement No. 18-688 with Kings View to provide CIT services in the Fresno Metropolitan area. Services include, but are not limited to: assessment, crisis intervention, community referrals and linkages, and short-term/brief case management. On September 20, 2022, the Board approved Amendment I to Agreement 18-688, to add Crisis Care Mobile Units grant funding and allow the DBH to host CIT for Youth training events. On September 20, 2022, the Board approved a Supersede Agreement No. 22-241 that retroactively changed the contractor’s name from Kings View Behavioral Health to Kings View. On June 20, 2023, the Board approved Supersede Agreement No. 23-303 to add DHCS CalAIM language. This agreement has been funded with MHSA PEI and Medi-Cal FFP revenue.
Through this grant, the DBH plans to expand the services currently provided by these existing CIT programs, to include two Mobile Crisis Support Teams dedicated to responding to crisis calls received from schools, K-12, within the Fresno County area. Expansion of these programs will establish a pilot project of trauma-informed mobile crisis support teams dedicated to providing culturally and linguistically appropriate behavioral health crisis intervention services to children and youth who experience a behavioral health crisis while in attendance at a Fresno County school. While the current CIT teams do respond to calls for children and youth and provide services at area schools, the two newly established teams will be dedicated to respond to calls only from this population and will also provide follow-up with the children and youth served, as well as their parents/caregivers, and the schools.
If approved, two (2) teams will be established - one to be added to the program established by Agreement No. 23-308 (Rural CIT) and one to be added to the program established by Agreement No. 23-303 (Metro CIT). The addition of these teams include the addition of two (2) clinicians, two (2) case managers, and four (4) vehicles to each program (total of four (4) clinicians, four (4) case managers, and eight (8) vehicles. These teams will be dedicated to responding to the calls received from the schools located in both the metropolitan and rural areas of Fresno. Services will include the established CIT services, as well as follow-up with the children and youth for at least thirty (30) days after the initial call response and education for the youth, parents/caregivers, and schools. Unlike the current programs, the clinicians on these two teams will receive calls directly from the schools’ resource officers and will not respond with a law enforcement presence, unless it is determined to be required. The goals of these two teams are to provide more efficient access to crisis services for this population, with the main goal of deescalating the situation to avoid an emergency room visit and/or placement within an inpatient facility. Additionally, awarded grant funds will be utilized for three months of start-up costs, information technology, furnishings, and equipment. Data gathered from the utilization and service provision during this pilot project will determine the County’s next steps, with regard to this program enhancement.
The recommended Agreement includes one-way indemnification and hold harmless language in favor of CHFFA and the State. The language is acceptable to the Department. The Department will be providing services on behalf of the contractor under this agreement and any claims will likely be the result of the County’s actions rather than that of the contractor.
Approval of the recommended actions will allow the Department to accept awarded CHFFA grant funding and amend the Kings View Rural and Metro CIT agreements to include CHFFA grant funding. The Department will return to your Board for approval of the amendments.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board will be notified of the recommended agreements at its August 2023 meeting.
REFERENCE MATERIAL:
BAI #46, June 20, 2023
BAI #33, October 25, 2022
BAI #26, September 20, 2022
BAI #46, June 21, 2022
BAI #32, December 11, 2018
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Resolution
On file with Clerk - Agreement with CHFFA
CAO ANALYST:
Ronald W. Alexander, Jr.