DATE: August 9, 2016
TO: Board of Supervisors
SUBMITTED BY: Dawan Utecht, Director, Department of Behavioral Health
David Pomaville, Director, Department of Public Health
SUBJECT: Retroactive State Application / Agreement for Substance Abuse and Mental Health Services Administration Community Mental Health Services Block Grant
RECOMMENDED ACTIONS:
TITLE
1. Approve and authorize the Chairman to execute a retroactive Application / Agreement with the State Department of Health Care Services, for Substance Abuse and Mental Health Services Administration Community Mental Health Services Block Grant funds for dual diagnosis mental health services in detention facilities, effective July 1, 2016 through June 30, 2017 ($1,873,865).
2. Approve and authorize the Director of the Department of Behavioral Health, or designee, to be the signatory on behalf of the Board of Supervisors on associated grant agreement documents, expenditure forms, reports or modifications to the budget line items, not to exceed ten percent of the maximum compensation.
REPORT
The Department of Behavioral Health (DBH) submitted a placeholder application, signed by the Department Director due to the short turnaround period for the State Department of Health Care Services (DHCS) annual Federal Substance Abuse and Mental Health Services Administration (SAMHSA) Community Mental Health Services Block Grant (MHBG). The Application / Agreement was released by DHCS on April 27, 2016 and was due to on July 1, 2016. Approval of the first recommended action will allow DBH to resubmit the Application / Agreement to DHCS in place of the initial Application / Agreement submitted as a placeholder. The grant allows counties to fund dual diagnosis mental health services in detention facilities for adults with serious mental illness (SMI) and juveniles with severe emotional disturbance (SED).
The second recommended action would allow the DBH Director to sign grant documents, expenditure forms, and reports on behalf of the Board and to approve requests to make changes within the budget, not to exceed ten percent of the maximum compensation. The grant allows funding for DBH and the Department of Public Health (DPH), with no increase in Net County Cost.
ALTERNATIVE ACTION(S):
If your Board chooses not to approve the recommended actions, the Departments will not receive these grant funds to provide mental health and substance use disorder treatment to individuals in adult and juvenile detention facilities. DBH will also have to return to your Board to seek signature for all necessary grant reports and forms for submittal to DHCS.
RETROACTIVE AGREEMENT:
The recommended Application / Agreement is retroactive to July 1, 2016. DHCS released notice of the FY 2016-17 SAMHSA MHBG application via electronic mail to the County on April 27, 2016 with a submission deadline of June 10, 2016. The deadline was extended to July 1, 2016 due to the review needed to address new MHBG requirements for community integration. The time period to prepare and review the recommended Application / Agreement did not allow presentation to your Board on an earlier date.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The County is eligible for FY 2016-17 SAMHSA MHBG grant funds in the amount of $1,873,865. The total grant funding ($1,873,865) includes a base allocation of $1,454,966 and dual diagnosis set-aside funds of $418,899. While the base allocation increased by $64,155 (or 4.6%) from the FY 2015-16 allocation, the total grant funding decreased by $26,363 (or 1.4%) due to DBH’s decision not to seek the First Episode Psychosis set-aside funds based on the uncertainty of future availability of funds. The grant does not require a County match and program expenses are 100% offset with these Federal funds. Sufficient appropriations and estimated revenues are included in the DPH Org 5620 ($1,533,865) and DBH Org 5630 ($340,000) FY 2016-17 Adopted Budgets.
DISCUSSION:
The County has received the SAMHSA MHBG funding since 1993, to provide mental health services to dually diagnosed adult and juveniles in detention facilities. The SAMHSA MHBG funds are allocated to county mental health departments for community mental health services for a specific target population. The base and dual diagnosis set-aside funding target population is SMI adults as well as SED children and adolescents. In 2014, SAMSHA required that states set aside five percent of their MHBG allocation to promote the development or enhancement of integrated program services for transition age youth (TAY), ages 15 to 30, who have experienced First Episode Psychosis (FEP). Although the County accepted FEP set-aside funding in FY 2014-15 to provide professional training and education to DBH’s existing TAY and First Onset - Psychosis (TAY/FOT) clinical and program staff, the programs elected to not continue receiving FEP funding for FY 2015-16 or 2016-17. The uncertainty of available FEP funding on a continuing basis did not meet the strategic planning for the programs.
The recommended Application / Agreement will enable the County to receive $1,533,865 to partially fund the adult Jail Psychiatric Services (JPS) program operated by Corizon Health, Inc. (Corizon). In FY 2015-16, JPS provided 3,400 unique client inmates with mental health services. Of those inmates served, 550 unique inmates were provided with dually diagnosed services. DPH, as the lead department over the Corizon program, estimates that 3,000 unique inmates will receive mental health services and 662 of these will receive specialized dual diagnosed services in FY 2016-17.
The recommended Application / Agreement also includes funding of $300,000 for the contracted provider, Mental Health System, Inc., to provide mental health services to SED juveniles with mental health and substance use disorders who are in custody or have recently been released from the Juvenile Justice Campus (JJC) and were overseen by DBH. The remaining funding amounts of $10,000 and $30,000 support the cost of facility services at the JJC and fund DBH’s staff time for administrative activities and periodic grant related expenditure reporting, respectively.
A total of 60 unique juvenile clients were served in FY 2015-2016 and it is projected that 80 juveniles will be served in FY 2016-2017. Of the 60 unique juveniles for FY 2015-16, outcome data has been collected on 56 juvenile clients who reached the six-month marker after completion of the program. Based on the collected data, it is projected that for FY 2016-17:
(1) 90% or 72 juveniles will be drug free six months after completion;
(2) 95% or 76 will have no new convictions during first six months after completion; and,
(3) 90% or 72 juveniles will attend school, work, or engaged in a vocational program six months after completion.
The DHCS approval process is contingent upon allocated federal funding. The recommended Application / Agreement will act as the final Agreement; the placeholder was submitted to meet the July 1, 2016 deadline. Your Board’s approval will allow DBH to submit an updated Application / Agreement to replace the placeholder. The recommended Application / Agreement contains language which allows the DBH Director, or designee, to modify services and budget line items within ten percent of the grant budget, in order to address program funding needs that may fluctuate over the term of the Agreement.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board members were notified of the SAMHSA MHBG grant funding at the July 2016 meeting.
REFERENCE MATERIAL:
BAI #29, October 13, 2015, Amendment I to Agreement No. 14-407 and Agreement No. 15-506
BAI #65, July 15, 2014, Agreement No. 14-407
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with DHCS
CAO ANALYST:
Sonia De La Rosa