DATE: March 28, 2017
TO: Board of Supervisors
SUBMITTED BY: Department of Behavioral Health
SUBJECT: Retroactive Amendment to Master Agreement for Prevention and Early Intervention Cultural Based Access Navigation and Peer Support Services
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute retroactive Amendment I to Master Agreement No. 16-359 with Cultural Based Access Navigation Specialist service providers, effective February 1, 2017 to June 30, 2021 and allowing for the reallocation of funds within the Master Agreement ($2,758,165).
2. Authorize the Director of the Department of Behavioral Health, or designee, to reallocate funding within Master Agreement No. 16-359 to contracted providers, as necessary, without exceeding the contract maximum.
REPORT
Approval of the first recommended action will reallocate funding within the Master Agreement to a Cultural Based Access Navigation and Peer Support Services (CBANS) provider addressing the needs of the incoming Syrian refugee population. This population is experiencing symptoms of mental illness, including post-traumatic stress, depression and anxiety because of displacement from their place of origin. Approval of the second recommended action will allow the Director of the Department of Behavioral Health, or designee, to reallocate funding within the Master Agreement to existing and/or new contracted providers as necessary to meet service needs, without exceeding the annual contract maximum. The Master Agreement is financed by Mental Health Services Act (MHSA) Prevention and Early Intervention (PEI) funds, with no Net County Cost.
ALTERNATIVE ACTION(S):
Non-approval of the first recommended action would not allow the Department to reallocate the funding to a provider addressing recent influx of Syrian refugees. Lack of culturally relevant services provided by the CBANS program will result in an escalation of mental illness symptoms and referrals to hospital emergency departments. Non-approval of the second recommended action would require the Department to return to your Board every time there is a change in service need requiring fund reallocation.
RETROACTIVE AGREEMENT:
The recommended amendment is retroactive to February 1, 2017 to relieve the provider, Fresno Interdenominational Refugee Ministries (FIRM), of the financial hardship that has resulted from the surge of Syrian refugees into the County. The Department was made aware of the service need in late fall of 2016, at which time community communications and planning began. On January 30, 2017, FIRM submitted their proposal for additional funding to serve the Syrian refugees. Proposal negotiations and drafting the amendment further delayed bringing this amendment to your Board. While not identified as a resettlement location for Syrian refugees, the County has historically drawn refugees from around the country. Currently there are approximately 125 Syrian refugees, an estimated 26 families, in the County with the number expected to double in FY 2017-18.
FISCAL IMPACT:
There is no Net County Cost associated with the recommended action. Services are fully funded by MHSA PEI funds. The CBANS Master Agreement annual contract maximum of $551,633, term maximum of $2,758,165, will remain unchanged. For services to the Syrian population, the annual budget for FIRM will increase from $120,393 as listed below:
• FY 2016-17 $155,604 ($35,211 increase)
• FYs 2017-18 through 2020-21 $205,149 ($84,756 increase)
There are no budget changes to the remaining providers. Sufficient appropriations and estimated revenues are included in the Department’s Org 5630 FY 2016-17 budget and will be included in future budget requests for the terms duration. Actual expenditures will be determined by actual services provided.
The recommended FIRM administrative costs for each FY are at 9% as compared to the total budget. The recommended FIRM employee benefits costs for each FY are at 17% as compared to the total salaries. The benefits calculation includes the full amount of employee health and retirement costs, life insurance, payroll taxes, State disability and unemployment insurance. Based on similar contract services, the percentages are reasonable for the administration of the program.
DISCUSSION:
As part of the MHSA PEI State mandated stakeholder process, CBANS services were initiated and approved by the California Department of Health Care Services (DHCS) as part of the MHSA Three-Year Plan. Funding provides wrap-around service intervention utilizing a holistic and culturally relevant approach, and delivered in a natural community setting. Services embody community collaboration, cultural and linguistic competency, individual/family driven values, a wellness/recovery focus, integrated services, and performance outcomes based.
On June 21, 2016, your Board approved Master Agreement No. 16-359 for CBANS services provided by the following:
• Fresno Interdenominational Refugee Ministries (FIRM);
• Fresno American Indian Health Project (FAIHP);
• Sarbat Bhala, Inc.;
• West Fresno Family Resource Center; and,
• Centro La Familia.
As noted on Attachment A, each provider has unique expertise in the provision of culturally and linguistically relevant services to unserved and underserved in the County. Services include, but are not limited to, outreach, education, early intervention, linkage to services, and help navigating various systems of care. Services are provided by Community Health Workers and Peer Support Specialists who are part of the communities they serve.
The CBANS program continues to meet or exceed program outcomes. For the period of July 2015 through June 2016, CBANS provided services to 5,810 unique individuals, 6,411 individual services, and participated in 324 outreach events at a cost-per-client of $75.36.
• Approximately 60% of individuals surveyed reported positive change in stress level.
• Approximately 83% of individuals surveyed in the program reported increased sense of hope within a six-month period.
• Approximately 79% of individuals surveyed reported increase in healthy behavior practices and better coping strategies.
The reallocation of funds to FIRM will provide the following services to Syrian refugees including, but not limited to:
• Workshops/Education Sessions: a minimum of one per month with an average attendance of 25 individuals per session;
• Peer Support Groups: a minimum of two peer support groups per month with an average attendance of 8 individuals;
• Case Management: a minimum of 45 active cases during the remaining FY 2016-17 and 90 active cases annually thereafter. Most, if not all Syrian refugees will require Case Management services, which will include intake and needs assessments, referrals and linkages to other programs, assistance with immigration, paying bills, finding healthy and affordable housing, accessing healthcare, and more.
• Outreach and Education to inform the community of services available in the County
• Referrals/Linkages: CBANS staff will provide at minimum 50 linkages/referrals to behavioral health and other community supports during the remaining FY 2016-17 and 120 linkages/referrals annually thereafter; and,
• Transportation: It is anticipated that a minimum of 100 clients will be transported to referral and linkage services during the remaining FY 2016-17 and 240 transported to referral and linkage services annually thereafter.
CBANS providers currently serve the following populations: Southeast Asian (Hmong, Lao and Cambodian), African Americans, African refugees/immigrants, Russian refugees/immigrants, Native Americans/Alaska Natives, Hispanic/Latino, and Punjabi. Inclusive within each population served are Veterans, homeless, and Lesbian/Gay/Bisexual/ Transgender/Questioning (LGBTQ) clients.
With your Board’s approval of the recommended actions, the Department will be able to reallocate funds to FIRM to address the influx of Syrian refugees that need assistance. Furthermore, the Department will be able to reallocate funds without returning to your Board and without exceeding the contract maximum.
OTHER REVIEWING AGENCIES:
The Behavioral Health Board was made aware of the recommended amendment during its March 21, 2017 meeting.
REFERENCE MATERIAL:
BAI #29, June 21, 2016, Agreement No. 16-359
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment I to Agt. No. 16-359 for CBANS
CAO ANALYST:
Sonia De La Rosa