SUBJECT
Title
AUTHORIZE ACCEPTANCE OF FUNDING FOR THE CHILDREN’S CRISIS CONTINUUM PILOT PROGRAM, AUTHORIZE COMPETITIVE SOLICITATIONS, AND AUTHORIZE APPLICATIONS FOR FUTURE FUNDING OPPORTUNITIES (DISTRICTS: ALL)
Body
OVERVIEW
In 2017, an urgent need was identified to provide more crisis care alternatives to hospitals for children and youth experiencing mental health crises due to gaps in availability of such services in California. As a result, the California legislature passed Assembly Bill (AB) 501 and authorized the California Department of Social Services (CDSS) to license short-term residential therapeutic programs (STRTP) to operate as children’s crisis residential programs. Crisis residential care, often an alternative to hospitalization, is an essential level of care for the treatment of children and youth with serious emotional disturbances in mental health crisis. Today, crisis treatment continues to remain unavailable to many children and youth in regions throughout California. With a renewed focus on addressing this issue in 2021, AB 153 was passed, which established the Children’s Crisis Continuum Pilot Program (CCCPP), a five-year program to be jointly implemented by CDSS and the Department of Health Care Services (DHCS). The purpose of CCCPP is to fully integrate the system of care for foster youth, enabling a seamless transition between service settings and to provide stabilization and treatment to foster youth with high acuity needs within the least restrictive setting possible. The County of San Diego (County) is among the eight counties and regional collaboratives that met the criteria for participating and have received preliminary awards from CDSS to take part in CCCPP.
Today’s action requests the Board authorize application to and acceptance of funding from CDSS and DHCS for the CCCPP, authorize a competitive solicitation for the procurement of a Children’s Crisis Residential program, authorize a competitive solicitation for the procurement of a Psychiatric Residential Treatment facility upon State approval of the pilot, and authorize the application for additional funding opportunity announcements to improve services to youth in the foster care system who are experiencing high acuity needs. This item supports the County’s vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished by expanding placement options, services, resources, and supports needed for foster youth with serious emotional disturbances in mental health crisis.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Authorize the acceptance of $8,500,000 in Children’s Crisis Continuum Pilot Program funds from the California Department of Social Services and Department of Health Care Services for the anticipated funding period of Fiscal Year (FY) 2023-24 through FY 2027-28 to improve services to youth in the foster care system who are experiencing substance use issues as well as mental health challenges, and authorize the Agency Director, Health and Human Services Agency, to execute all required grant documents, including all amendments thereto.
2. In accordance with Section 401, Article XXIII of the County Administrative Code, authorize the Director, Department of Purchasing and Contracting, to issue a competitive solicitation for a Children’s Crisis Residential Program, and upon successful negotiations and determination of a fair and reasonable price, award contracts for an initial term of up to one (1) year, with four (4) one-year option periods, and up to an additional six months, if needed; and to amend the contracts to reflect changes in program, funding or service requirements, subject to the availability of funds and the approval of the Agency Director, Health and Human Services Agency.
3. In accordance with Section 401, Article XXIII of the County Administrative Code, authorize the Director, Department of Purchasing and Contracting, to issue a competitive solicitation for a Psychiatric Residential Treatment Facility upon state approval for the pilot, and upon successful negotiations and determination of a fair and reasonable price, award contracts for an initial term of up to one (1) year, with four (4) one-year option periods, and up to an additional six months, if needed; and to amend the contracts to reflect changes in program, funding or service requirements, subject to the availability of funds and the approval of the Agency Director, Health and Human Services Agency.
4. Authorize the Agency Director, Health and Human Services Agency, or designee, to apply for any additional funding opportunity announcements, if available, to improve services to youth in the foster care system who are experiencing high acuity needs.
EQUITY IMPACT STATEMENT
The County of San Diego Child and Family Well-Being Department (CFWB), recognizes the impact that placement in foster care has on adolescents, in addition to the trauma that youth may experience in other aspects of their life. In Fiscal Year 2021-22, CFWB, Office of Child Safety (OCS), received 39,025 reports of abuse and neglect to the Child Abuse Hotline, representing 67,824 children. Upon investigation and confirmation that abuse or neglect occurred, cases may be opened with the CFWB, OCS. As of May 2023, there were 2,607 children and youth with an open case with CFWB, OCS, of whom 1,852 reside in out-of-home placements. Among children in out-of-home placements, 121 youth reside in residential programs and require a higher level of care due to experiencing substance use and mental health challenges. The population distribution by ethnicity of the children residing in residential programs includes 49% Hispanic, 34% White, 34% Black, 2% Asian, and 2% Native American. Additionally, there were approximately 37 youth at Polinsky Children's Center awaiting placement, many of whom met the criteria for receiving higher levels of care, highlighting the need to improve the continuum of services for youth in the foster care system in San Diego County.
The proposed Children’s Crisis Continuum Pilot Program (CCCPP) is designed to reduce the reliance for care in emergency rooms and psychiatric hospitals and fulfills a need by providing an alternative to hospitalization for youth experiencing acute mental health crises. This level of care is part of the full continuum of care considered medically necessary for many children with serious emotional disturbances in crisis. Implementing the CCCPP in San Diego County would yield support to critical components of the continuum of care that are currently not available in the region, advancing the County’s efforts to respond to the need for intensive mental health services by expanding capacity to serve foster youth with high acuity mental health needs.
SUSTAINABILITY IMPACT STATEMENT
Today’s actions support the County of San Diego’s (County) Sustainability Goal #1, to engage the community in meaningful ways and to foster inclusive and sustainable communities; and Sustainability Goal #2, to provide just and equitable access to County services. Throughout the Children’s Crisis Continuum Pilot Program (CCCPP) planning and design process, special attention was given to engaging key community partners and stakeholders in meaningful discussions about CCCPP’s design and implementation plan. By implementing the CCCPP locally, the County will increase services and supports to youth experiencing high acuity needs, eliminate the placement of foster youth with complex needs in out of county facilities whenever possible, and invest in building resilience in vulnerable populations in partnership with the communities.
FISCAL IMPACT
Recommendation 1: Authorize acceptance of $8,500,000 in Children’s Crisis Continuum Pilot Program funds from the California Department of Social Services and Department of Health Care Services for the anticipated funding period of Fiscal Year (FY) 2023-24 through FY 2027-28.
Funds for this request are included in FY 2023-25 Operational Plan in the Health and Human Services Agency (HHSA). If approved, this request will result in estimated annual costs and revenue of $1.2 million in FY 2023-24 and estimated costs and revenue of $2.9 million in FY 2024-25. Costs and revenue are expected through FY 2027-28 for a total of $8.5 million. The funding source is State General Fund via the California Department of Social Services and Department of Health Services. There will be no change in net General Fund cost and no additional staff years.
Recommendations 2&3: Issue competitive solicitations for a Children’s Crisis Residential Program and a Psychiatric Residential Treatment Facility.
Funds for this request are included in FY 2023-25 Operational Plan in HHSA. If approved, there will be no fiscal impact in FY 2023-24 and estimated costs and revenue of $2.9 million in FY 2024-25. The funding sources are Social Services Administrative Revenue, State General Fund, and Realignment. There will be no change in net General Fund cost and no additional staff years.
Recommendation 4: Authorize applications for additional funding opportunity announcements to improve services to youth in the foster care system who are experiencing high acuity needs.
There is no fiscal impact associated with this action. There will be no change in net General Fund costs and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
This item will be presented as an informational item to the Child and Family Strengthening Advisory Board at its regular meeting on July 28, 2023.
BACKGROUND
In 2017, an urgent need was identified to provide more crisis care alternatives to hospitals for children and youth experiencing mental health crises due to gaps in availability of such services in California. According to California legislature, children and youth in mental health crisis often faced long wait times for a hospital bed and were transported, without a parent, to a facility far from home in order to access necessary treatment services. As a result, Assembly Bill (AB) 501 was passed, which authorized the California Department of Social Services (CDSS) to license short-term residential therapeutic programs (STRTP) to operate as children’s crisis residential programs. Crisis residential care, often an alternative to hospitalization, is an essential level of care for the treatment of children and youth with serious emotional disturbances in mental health crisis. Today, crisis treatment continues to remain unavailable to many children and youth, especially those in foster care, in regions throughout the State.
With a renewed focus on addressing this issue in 2021, California legislature passed AB 153. To be jointly implemented by CDSS and the California Department of Health Care Services (DHCS), AB 153 established the Children’s Crisis Continuum Pilot Program (CCCPP). CCCPP is a five-year pilot which set out criteria for foster youth eligibility, and the selection, operation, and evaluation of pilots intended to keep youth in families to the greatest possible degree based on the best interest of the youth, and to eliminate placement of foster youth with complex needs in out-of-state facilities. As a result, CDSS and DHCS engaged with various impacted stakeholders throughout the State including local jurisdictions, tribes, foster youth and families, youth advocates, service providers, and community-based organizations serving youth to design the implementation and selection criteria for participating in the pilot program. The County of San Diego (County) is among the eight counties and regional collaboratives that met the participation criteria and have been notified of preliminary award amounts to take part in CCCPP.
Locally as of May 2023, the County’s Department of Child and Family Well-being (CFWB), Office of Child Safety, had 121 youth who were receiving services in residential settings. Additionally, there were approximately 37 youth at Polinsky Children's Center awaiting placement, many of whom met the criteria for receiving higher levels of care. Locating placements for youth with high acuity mental health needs continues to be a challenge as they frequently move between congregate care settings, hospitals, and detention facilities while attempting to stabilize. This may result in placement of youth outside of San Diego County. An additional complicating factor is placement options for youth with high medical, developmental, and/or behavioral health needs or those being served by the Probation Department. Currently not all local facilities are able to support youth with complex care needs and in crisis, as such facilities require additional training, support, resources, and coordination of care. These challenges are exacerbated as a result of existing gaps in availability of crisis residential care for foster youth in San Diego County. Implementing the CCCPP in San Diego County would yield support to critical components of the continuum of care for foster youth with high acuity needs.
In order to develop the design and implementation plan of CCCPP in San Diego County, CFWB, in partnership with the County Behavioral Health Services Department, engaged various key partners including the County Probation Department, San Diego Regional Center, San Diego County Office of Education, Tribal Nations, California Department of Rehabilitation, Promises2Kids, and San Diego Center for Children. Through these discussions, it was determined that it is critical for the County’s plan to ensure seamless entry and transition through the continuum of care through enhanced care coordination and improved service availability. This can be accomplished through working collaboratively with service providers to tailor services around the needs of foster youth and identifying the appropriate level of care with a commitment to transitioning youth to a lower level of care to ensure continuity of care and placement stability. The County’s proposed pilot includes four main components: Intensive Services Foster Care; Crisis Stabilization; Children’s Crisis Residential Program; and Care Coordination to include linkages to community resources. Upon approval of today’s actions, the pilot will be implemented in stages to support the additional planning and collaboration with involved partners and procurement processes.
Intensive Services Foster Care
Intensive Services Foster Care (ISFC) homes serve children who require intensive treatment, behavioral supports, and specialized health care needs, in a home-based family care setting. Currently the County works in partnership with eight FFAs, seven of which have approved ISFC programs (a total of 62 beds). As ISFC eligible youth are identified, the pilot plans to leverage 16 of the ISFC beds across FFAs who opt in, allowing for maximum flexibility, utilization, and matching of youths’ needs to the right resource family. It is anticipated additional FFAs will be providing this resource in San Diego County in the future, which may result in additional ISFC beds. The ISFC beds that will be funded through the CCCPP will be located in the central area of the county, within close proximity to the existing County-contracted Crisis Stabilization Unit (CSU), specialized to serve children and adolescents under the age of 18. The close proximity to this facility would result in an enhanced accessibility to crisis stabilization services if deemed necessary.
Crisis Stabilization
A Crisis Stabilization Unit (CSU) is a 24-hour health care facility with a maximum stay of 23 hours, 59 minutes that provides emergency psychiatric evaluations, crisis intervention, crisis stabilization, brief outpatient counseling, case management and emergency medication management to children and adolescents under age 18. The existing County-contracted CSU, known as Emergency Screening Unit (ESU), currently has 12 Crisis Stabilization beds. Four of the existing CSU beds will be dedicated for the CCCPP to ensure beds are available for youth in the pilot when need is identified. Through enhanced care coordination, this will assure seamless transitions within the crisis continuum, to avoid the need for children to be moved into higher levels of care. The CSU is managed through an existing BHS contract and ongoing communication will occur with the provider to ensure they are familiar with CCCPP, expectations, and emerging needs.
Children's Crisis Residential Program
Children’s Crisis Residential Programs (CCRP) are licensed by CDSS to operate as STRTPs and have a mental health program approved by the DHCS. CCRP services are available seven days a week, 24 hours a day, for children and youth up to age 21 experiencing an acute mental health crisis as an alternative to psychiatric hospitalization. Currently a CCRP facility does not exist in San Diego County. The proposed pilot would result in four new CCRP beds, which would be a critical component in the local crisis care continuum. Services provided by CCRPs include but are not limited to, assessment, plan development, therapy, medication support, rehabilitation, collateral, and crisis intervention. Services are short-term with an anticipated length of stay of ten consecutive days unless the child meets the criteria for a longer stay. Upon approval of today’s action, a competitive procurement will be issued upon approval in July of 2024 for a CCRP serving no more than four foster youth at a time. Per California legislation signed in September 2022, CCRPs may be integrated to function as Psychiatric Residential Treatment Facilities (PRTF) upon approval by DHCS. PRTFs are non-hospital facilities offering intensive inpatient services to individuals under the age of 21 with behavioral health conditions. It is anticipated that the regulations necessary to obtain a license for PRTF will be established by 2027. As part of its commitment to supporting the regions continuum of care, the Health and Human Services Agency will explore options to integrate CCRPs to PRTFs once updated regulations are released and anticipated legislation enacted, and will update the Board of significant developments.
Care Coordination to Include Linkages to Community Resources
The County will provide enhanced care coordination and intensive transition planning for youth in the pilot through the County contracted Foster Family Agency Stabilization and Treatment program. Transition teams will tailor to the needs of youth and families in order to provide treatment options, as well as identification of and access to community supports and services, referrals to transition to a lower level of care, assist caregivers and families to prepare for return of youth back to home, and work towards long-term permanency. The care coordination enhancement for this pilot will occur through an amendment to a BHS specialty mental health service contract (#567115) with San Diego Center for Children. Each assigned care coordinator would be enabled to respond to youth in time of crises and would monitor access to services to ensure youth remain in the appropriate level of care.
The model that the County has developed for this pilot is reflective of contributions from engagement with various key stakeholders and is expected to further advance the coordination of service delivery to this population. Eligible youth who will be participating in the pilot will be followed by a care coordinator, who will communicate directly with treatment and placement facilities and providers to minimize placement changes. Additionally, these youth will have access to a wide array of additional resources such as mentors, family finding and permanency roundtables, and more services to support them in achieving permanency. The four components of the pilot will be implemented in stages to support the additional planning and collaboration with involved partners and procurement processes, with the pilot anticipated to be operational in 2024. Once fully implemented, the County is committed to gathering, tracking, and providing CDSS and DHCS with information regarding the pilot youth progress at set intervals to include the following anticipated outcomes: reduced hospitalizations for youth in the foster care or juvenile justice system, reduced number of interactions with law enforcement, reduced placement changes, improved permanency outcomes, and increased familial connections.
Today’s action requests the Board authorize the acceptance of funding from CDSS and DHCS for the CCCPP. Additionally, today’s action requests the Board authorize a competitive solicitation for the procurement for a Children’s Crisis Residential Program and authorize a competitive solicitation for the procurement of a Psychiatric Residential Treatment Facility upon State approval of the pilot. Additionally, today’s action requests the Board authorize the Agency Director, Health and Human Services Agency, or designee, to apply for additional funding opportunity announcements to improve services to youth in the foster care system who are experiencing high acuity needs.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed actions support the County of San Diego’s 2023-2028 Strategic Plan Initiatives of Sustainability (Economy and Resiliency), Equity (Health and Economic Opportunity), Empower (Workforce, Transparency, Accountability, and Innovation), and Community (Engagement, Quality of Life, Communications, and Partnership) by providing a strengthened child and family system that ensures the safety and well-being of children and families and supports the foster care community.
Respectfully submitted,
HELEN N. ROBBINS-MEYER
Interim Chief Administrative Officer
ATTACHMENT(S)
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