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DATE: |
February 28, 2023 |
04 |
SUBJECT
Title
AUTHORIZE COMPETITIVE SOLICITATIONS TO EXPAND BEHAVIORAL HEALTH SERVICES PROGRAMMING TO ENGAGE FATHERS AND CAREGIVERS (DISTRICTS: ALL)
Body
OVERVIEW
Under the leadership of the San Diego County Board of Supervisors, the County of San Diego (County) is making strategic investments to move the local behavioral health care delivery system from a model of care driven by crises to one centered on continuous, coordinated care and prevention. These efforts, broadly referred to as the Behavioral Health Continuum of Care (Continuum of Care), are guided by data, focused on equity, and designed to engender collaborative work, within and outside of government. In addition to expanding regionally distributed services to improve access to care, the Continuum of Care strategy is also achieved through actions that build upon the success of existing programs by enhancing and expanding services that are informed by community input and clinical best practices.
To understand current community needs for parenting program services and identify program development opportunities to enhance prevention services, County Health and Human Services Agency, Behavioral Health Services (BHS) completed a series of community input activities with local stakeholders to:
• Evaluate the effectiveness and relevancy of existing parenting program services,
• Learn best practices for delivering culturally reflective and community-specific services that build resiliency,
• Offer supports for parents and caregivers, and
• Activate protective factors for children and their families.
Through these activities, BHS identified the need to implement an Adverse Childhood Experiences (ACEs) Prevention Parenting Program for Fathers, to build upon existing programming currently focused within the Central Region and expand efforts to support the engagement, participation, and parenting skills development for fathers with children up to the age of 18, and to provide augmented services countywide. Approval of today’s recommended action authorizes one or more competitive solicitations to implement and expand these services countywide.
This item supports the County’s vision of a just, sustainable, and resilient future for all, specifically those communities and populations that have been historically left behind. This item also supports the ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities by expanding critical behavioral health services for children, youth, and their families.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. In accordance with Section 401, Article XXIII of the County Administrative Code, authorize the Director, Department of Purchasing and Contracting, to issue one or more competitive solicitations for the Adverse Childhood Experiences (ACEs) Prevention Parenting Program for Fathers in all six Health and Human Services Agency service regions, and upon successful negotiations and determination of a fair and reasonable price, award contracts for an initial term of up to one year, with four option years, 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.
EQUITY IMPACT STATEMENT
County of San Diego Health and Human Services Agency, Behavioral Health Services (BHS) serves as the specialty mental health plan for Medi-Cal eligible residents within San Diego County with serious mental illness, and the service delivery system for Medi-Cal eligible residents with substance use disorder care needs. These individuals and families often experience disproportionate barriers due to social, economic, and environmental factors that may negatively impact their behavioral health. These factors, referred to as the social drivers of health, are rooted in inequitable distribution of resources.
As a steward of public health for the region, BHS must ensure that the services offered through County-operated and contracted programs address the social drivers of health by being accessible, capable of meeting the linguistic and cultural needs of a diverse population, and equitably distributed to the individuals, families, and communities most in need. BHS utilizes a population health approach, along with evidence-based practices, robust data analysis, and stakeholder input from consumers, community-based providers, healthcare organizations and others to identify need and design services that are impactful, equitable, and yield meaningful outcomes for clients.
If approved, today's action will award contracts to provide culturally and community reflective Prevention and Early Intervention services to families throughout San Diego County who are underserved by behavioral health resources and supports. These upstream services are anticipated to reduce health system silos, improve access to care, and mitigate the impact of social drivers of health, using a whole-family approach.
SUSTAINABILITY IMPACT STATEMENT
The proposed action to provide services that prevent, mitigate, and improve access to treatment and care for communities and populations who are underserved by social and behavioral health resources, will result in sustainability enhancements in terms of health/wellbeing, equity, economy, and environment. Awarding contracts for these services will contribute to County of San Diego (County) Sustainability Goal #2 to provide just and equitable access to County services by providing a wider availability and range of supportive, inclusive, and stigma-free options. Services will first improve the overall health of communities, reducing the demand of associated care services, while then increasing effectiveness of care providers and lowering operating costs of facilities, thus reducing emissions and waste generated within the care sector.
FISCAL IMPACT
Funds for these requests are not included in the Fiscal Year (FY) 2022-24 Operational Plan in the Health and Human Services Agency. If approved, today’s recommendations will result no costs and revenue in FY 2022-23 and estimated costs and revenues of up to $2.04 million in FY 2023-24. The funding source is Mental Health Services Act revenue. Funds for subsequent years will be incorporated into future operational plans. There will be no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
At their regular meeting on February 2, 2023, the Behavioral Health Advisory Board voted to approve this item.
BACKGROUND
Under the leadership of the San Diego County Board of Supervisors, the County of San Diego (County) is taking action and making strategic investments to move the local behavioral health care delivery system from a model of care driven by crises to one centered on continuous, coordinated care and prevention. These efforts, broadly referred to as the Behavioral Health Continuum of Care (Continuum of Care), are guided by data, focused on equity, and designed to engender collaborative work, within and outside of government. In addition to expanding regionally distributed services to improve access to care, the Continuum of Care strategy is also achieved through actions that build upon the success of existing programs by enhancing and expanding services that are informed by community input and clinical best practices.
Strengthening Protective Factors for Children and Youth
The Continuum of Care strategy is applicable to all ages in that integrated and preventative services are the key to improved outcomes over time and should be tailored in ways that reduce health disparities. Evidence is clear that implementing earlier interventions in the lives of young people is the best way to build protective factors, promote resiliency, and wellbeing, and parent and caregiver engagement is critical for the mental health development in children. In particular, support for fathers, father figures, and male caregivers presents a greater need, as evidenced by a June 2021 Special Topic Report produced by the University of California San Diego (UCSD) Research Centers regarding Reducing Mental Health Stigma in San Diego County. Survey findings from this report showed that male respondents were more likely than female respondents to delay obtaining help because they were concerned about what others would think (52% vs. 15%).
In addition to engaging and supporting fathers, strategies to overcome Adverse Childhood Experiences (ACEs) and toxic stress remain a top priority as they represent a public health crisis associated with 9 of the 10 leading causes of death in the United States, according to the Centers for Disease Control and Prevention. ACEs can include physical and emotional abuse, neglect, caregiver mental illness, and household violence. Experiencing many ACEs can excessively activate a person’s stress-response system and lead to long-lasting negative impacts on the brain and body. Scientific consensus demonstrates that cumulative adversity, in the absence of protective factors, is a root cause for poor health and social outcomes that can be passed down from generation to generation, according to the American Academy of Pediatrics. Parenting and caregiver skill development and strengthening engagement of fathers have been demonstrated as practices which support positive childhood experiences and reduction of the impacts of ACEs.
Expanded Services Informed by Community Input
County Health and Human Services Agency, Behavioral Health Services (BHS) currently funds two main Prevention and Early Intervention programs in San Diego County focused on the delivery of parenting program services: the Positive Parenting Program which has been operational since 2009 and the Father 2 Child Program which has been operational since 2012. Both of these programs strengthen parent and caregiver skills, but the latter program places an emphasis on services for fathers, improving attitudes towards fathering, and strengthening engagement of fathers in their children’s lives to prevent and address risks associated with ACEs through “Parent Skills” training and engagement. Father 2 Child Program activities and services include curriculum-based group education, individual counseling, outreach and education, flex funds to support employment (e.g., purchase of tools and uniforms), and annual recreational opportunities for children and fathers to connect with one another. For the current contract year to date the Father 2 Child Program has reached 137 children and 95 fathers. Follow up surveys indicated participants had increased interaction time with children, awareness on fathering knowledge and positive attitudes towards fathering, positive parenting experiences, and healthier interactions with the child’s mother.
Recognizing the benefit of these two existing parenting program services and growing community need, BHS completed a series of community input activities with local stakeholders to evaluate the effectiveness and relevancy of existing parenting program services and learn best practices for delivering culturally reflective and community-specific services that build resiliency, offer supports for parents and caregivers, and activate protective factors for children and their families. These activities solicited feedback from stakeholders across multiple sectors and have informed BHS’ program development process over the last several months.
Additionally, BHS held a Request for Information to seek input from industry experts and behavioral health service providers; conducted focus group discussions with parents and child development professionals; and reviewed best practices for culturally competent and community specific outreach and engagement practices in collaboration with UCSD research partners. Through this process, BHS identified the need to augment the existing parenting program services for fathers in particular by expanding services countywide, enhancing options for culturally competent regional curriculums and practices, and addressing barriers to engagement and retention by offering transportation, flexible hours, and multiple formats for participation.
Approval of today’s recommended action authorizes one or more competitive solicitations to implement expanded parenting program services for fathers across San Diego County.
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 Equity (Health) and Community (Quality of Life) as well as the regional Live Well San Diego vision of healthy, safe, and thriving communities. This is accomplished by reducing disparities and disproportionality of individuals with mental health and substance use conditions and ensuring access to a comprehensive continuum of behavioral health services administered through accessible behavioral health programs.
Respectfully submitted,
HELEN N. ROBBINS-MEYER
Chief Administrative Officer
ATTACHMENT(S)
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