DATE: June 18, 2019
TO: Board of Supervisors
SUBMITTED BY: Dawan Utecht, Director, Department of Behavioral Health
SUBJECT: Submission of the County of Fresno Mental Health Services Act Annual Update (FY 2018-19) and the Prevention and Early Intervention Evaluation Report (FY 16-17 to FY 17-18)
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Department of Behavioral Health to submit the County of Fresno Mental Health Services Act Annual Update FY 2018-19 ($79,541,980) and the Prevention and Early Intervention Evaluation Report (FY 2016-17 to FY 2017-18) to the California Department of Health Care Services and the California Mental Health Services Oversight and Accountability Commission.
REPORT
Approval of the recommended action will allow the Department to submit the County’s Mental Health Services Act (MHSA) FY 2018-19 Annual Update and the Prevention and Early Intervention Evaluation Report (FY 2016-17 to FY 2017-18) to the California Department of Health Care Services (DHCS) and the California Mental Health Services Oversight and Accountability Commission (MHSOAC) by June 30, 2019. Pursuant to Welfare & Institutions Code (W&IC), section 5847, the Annual Update is a process whereby the County outlines the MHSA-funded programs and services according to community stakeholder input and the Community Program Planning Process (CPPP). The programs and services are provided to behavioral health clients, their family members and target populations throughout the County with no increase to Net County Cost.
ALTERNATIVE ACTION(S):
Your Board may choose not to approve the Annual Update and Report; however, it would result in failure to adhere to the required statutes and would delay the Department’s efforts to provide needed behavioral health services in the community. Additionally, non-approval may place MHSA funds at risk of reversion to the California Department of Health Care Services (DHCS) as the funds are subject to expenditure time limits. Further, if your Board recommends significant changes to the plan, the Department will be required to re-engage the community, as part of the stakeholder process, further delaying the submission of the plan.
FISCAL IMPACT:
There is no increase in Net County Cost associated with this recommended action. MHSA funding allows for full reimbursement of direct and indirect program and service costs. The FY 2018-19 program and service costs ($79,541,980) are detailed in the FY 2018-19 Annual Update. The Annual Update was included in the previously approved FYs 2017-18 through 2019-20 Three-Year Plan. The total funding for the FYs 2017-18 through 2019-20 Three-Year Plan is $237,421,283:
FYs 2017-18 through 2019-20 Three-Year Plan
FY 2017-18: $ 75,097,363
FY 2018-19: $ 79,541,980
FY 2019-20: $ 82,781,940
TOTAL: $237,421,283
Your Board approved the existing MHSA funded programs. As part of the Annual Update, amendments to existing programs and new proposed programs would be brought to your Board for approval prior to implementation. Sufficient appropriations and estimated revenues are included in the Departments’ Org 5630 FY 2018-19 Adopted Budget and will be included in subsequent budget requests.
DISCUSSION:
The Annual Update, execution of the CPPP and the Prevention and Early Intervention Evaluation Report are required for the Department to continue receiving funds to provide MHSA services. During the planning phase, the Department provides the status of existing and future services financed with the funds, including outcome, successes achieved, and challenges encountered. The update process is used to request changes to existing approved programs, to request new programs, as well as to make additional fiscal and programmatic changes. Welfare and Institutions Code 5848 mandates a robust and meaningful stakeholder process, through the CPPP. The Department provides community stakeholders the opportunity to identify system gaps and/or submit requests for service, allowing counties to continually evaluate program performance and make changes, amendments, additions, and/or eliminations, as necessary.
On December 5, 2017, your Board approved the MHSA FY 2017-18 through FY 2019-20 Three-Year Program and Expenditure Plan. The FY 2018-19 Annual Update is incorporated into the recommend Three-Year Plan and reports on activities and recommends changes to MHSA-funded programs based on FY 2018-19 program outcomes; specifically, programs added, deleted, and/or enhanced from the previously submitted plan. The plan is comprehensive, based on data collected through the CPPP, and communicates ongoing needs, gaps, and changes to existing programs. The CPPP process and stakeholder recommendations provide data, which supports the development of new programs, updates to existing programs, program consolidations, and/or adjustments or enhancements to programs and activities. The recommendation also includes fiscal and programmatic changes, and designates funds to the Capital Facilities Fund.
The proposed update and plan outlines a system of care in accordance with MHSA core values through five work plans identified by the Department, which are the core of the Department’s needs assessment, gap analysis, and future program planning. The work plans include:
1. Behavioral Health Integrated Access
2. Wellness, Recovery and Resiliency Support
3. Cultural/Community Defined Practice
4. Behavioral Health Clinical Care
5. Infrastructure Support
Each work plan has a clear focus described on Attachment A and does not narrowly or exclusively classify any program or activity, but rather provides an organizing framework. The Department will utilize the work plans as the framework to report on activities and processes. Additionally, the plans will be used in Department-wide staff meetings, meetings with contractors, meetings with other community partners, and in other community-based forums.
The required 30-day public review and comment period began with the posting of the drafts on the County’s MHSA website from April 12, 2019 through May 14, 2019. A public hearing was conducted on May 15, 2019 and hosted by the Behavioral Health Board (BHB). In addition, the drafts were widely distributed to community-based organizations, client and family advocacy groups, community partners, and other stakeholders.
The update and plan covers the five MHSA components including Community Services and Supports (CSS) and Housing; Prevention and Early Intervention (PEI); Workforce Education and Training (WET); Innovation (INN); and, Capital Facilities and Technology Needs (CFTN). Currently, the Department has:
• 39 CSS programs,
• 16 PEI programs,
• 4 WET action plans,
• 5 INN plans (total of 7 with possible plans approved by the stakeholders for reversion)
• Capital facilities improvements for on-going projects, the acquisition of new property, the building of a new crisis treatment center, 1 IT project, and 3 permanent supportive housing projects.
With your Board’s approval, the FY 2018-19 Annual Update will be submitted to MHSOAC, which will meet the statutory requirement.
OTHER REVIEWING AGENCIES:
On May 15, 2019, the Behavioral Health Board (BHB) held the public hearing at the County of Fresno Health and Wellness Center. On the same date, the BHB voted unanimously to accept the County of Fresno MHSA FY 2018-19 Annual Update and the Prevention and Early Intervention Evaluation Report and recommend it for presentation to your Board for approval.
REFERENCE MATERIAL:
BAI #27, November 6, 2018
BAI #5, December 5, 2017
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Mental Health Services Act Annual Update and PEI Prevention and Early Intervention Evaluation Report
CAO ANALYST:
Ronald Alexander