SUBJECT
Title
AUTHORIZE COMPETITIVE SOLICITATIONS, SINGLE SOURCE CONTRACTS, AMENDMENTS TO EXTEND EXISTING CONTRACTS, AND COOPERATIVE AND REVENUE AGREEMENTS FOR BEHAVIORAL HEALTH SERVICES (DISTRICTS: ALL)
Body
OVERVIEW
The County of San Diego (County) Health and Human Services Agency, Behavioral Health Services provides a comprehensive array of mental health and substance use services to people of all ages. These services are delivered through County-operated programs, as well as contracts with community service providers. Those served include vulnerable populations, including individuals who are experiencing homelessness, individuals with justice involvement, and children and youth with complex behavioral health conditions.
Today’s actions recommend the San Diego County Board of Supervisors authorize competitive solicitations, single source contracts, amendments to extend existing behavioral health services contracts, and cooperative and revenue agreements, to sustain critical behavioral health services, with the goal of building a better behavioral health service delivery system for San Diego County communities. Today’s recommended actions include the procurement of new services to provide diagnostic and clinical treatment services to children and youth under the age of 21 with specialty mental health needs, inclusive of substance use co-occurring needs. These programs support the County’s efforts to respond to local need for intensive mental health services by expanding the levels of care available to serve children and youth. These recommended actions support the continuation of critical work to advance behavioral health continuum of care throughout San Diego County.
Today’s actions support 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 upholding practices that align with community priorities and improving transparency and trust while maintaining good fiscal management.
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 competitive solicitations for behavioral health services listed below, 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 1-year Options, 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.
a. Assertive Community Treatment Services
b. Behavioral Health Patient Rights Education and Advocacy Services
c. Supported Employment Technical Consultant Services
d. Supported Employment Continuum
e. Faith-Based Behavioral Health Training, Education Academy and Community Education
f. Faith-Based Wellness and Mental Health In-Reach Ministry
g. Jail In-Reach
h. Incredible Families
i. Multicultural Community Counseling
j. Intensive Case Management Wraparound Services
k. Early Intervention for Prevention of Psychosis Program
l. Community Harm Reduction Team
m. Support Services for Women Experiencing Homelessness
n. Adult Substance Use Outpatient Program
o. Adult Substance Use Residential Program
p. Perinatal Substance Use Residential Program
q. Adolescent Substance Use Residential Program
r. Adult Substance Use Outpatient Program for Alcohol Use
s. Peer Support Services
t. Behavioral Health Services for AB109 Clients
u. Intensive Outpatient Program and Partial Hospitalization Program
2. In accordance with Board Policy A-87, Competitive Procurement, approve and authorize the Director, Department of Purchasing and Contracting, to enter into negotiations for behavioral health services listed below, and subject to successful negotiations and determination of a fair and reasonable price, enter into single source contracts for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, subject to the availability of funds and the approval of the Agency Director, Health and Human Services Agency.
a. Electroconvulsive Therapy Services
b. Medi-Cal Managed Care Psychiatric Inpatient Hospital Services
c. Skilled Nursing Facility
i. Skilled Nursing Facility for Adults with Behavioral Health Conditions
ii. Skilled Nursing Facility with Special Treatment Program
d. Short Term Residential Therapeutic Programs
e. School-Based Outpatient Behavioral Health Services
3. In accordance with Board Policy A-87, Competitive Procurement, and Administrative Code Section 401, authorize the Director, Department of Purchasing and Contracting, subject to successful negotiations and a determination of a fair and reasonable price, to amend the contracts listed below to extend the contract term and expand services, subject to the availability of funds; and amend the contracts as required in order to reflect changes to services and funding allocations, subject to the approval of the Agency Director, Health and Human Services Agency.
a. Extend the contract term up to December 31, 2024, and up to an additional six months, if needed:
i. Placement Stabilization Services at Polinsky Children's Center
• New Alternatives, Inc. (Contract #556401)
b. Extend the contract term up to December 31, 2024:
i. Breaking Down Barriers Initiative
• Jewish Family Service of San Diego (Contract #559599)
c. Extend the contract term up to June 30, 2027, and up to additional six months, if needed:
i. Behavioral Health Administrative Services Organization (dba Optum)
• United Behavioral Health (Contract #553848)
d. Extend the contract term up to June 30, 2024, and up to an additional six months, if needed:
i. Behavioral Health Collaborative Court
• Telecare Corp. (Contract #551670)
4. In accordance with Board Policy B-29, authorize the Agency Director, Health and Human Services Agency, upon receipt, to execute the following Agreements.
a. Cooperative Agreement with the State Department of Rehabilitation for Mental Health Employment Services
b. Revenue Agreement with Driving Under the Influence Program
EQUITY IMPACT STATEMENT
The County of San Diego (County) 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 who are experiencing serious mental illness or serious emotional disturbance, and the service delivery system for Medi-Cal eligible residents with substance use care needs. An estimated 5% of San Diegans ages 21 years and older have a serious mental illness (SMI). While SMI is prevalent in all our communities, there are certain groups that have disproportionately high rates of SMI. Particularly, 2021 data from the California Department of Healthcare Access and Information indicate that rates among Black/African American residents were 145% higher compared to others. Additionally, according to the California Health Interview Survey conducted by the University of California Los Angeles in 2021, 10% of San Diegans reported experiencing serious psychological distress in the past month. However, residents living below 200% of the federal poverty level, those who reported a history of incarceration, or who identified as black, Hispanic/Latino, Asian, or multiracial, reported higher percentages of serious psychological distress compared to others. 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 determinants of health by being accessible, capable of meeting the needs of diverse populations, and with the intent to equitably distribute services to those most in need.
In support of these efforts, BHS utilizes a population health approach to identify needs and design services in a manner most impactful, equitable, and yield meaningful outcomes for those served. This includes facilitating ongoing engagement and input from the community, stakeholders, consumers, family members, community-based providers, and healthcare organizations through formal and informal convenings, along with cross-collaboration with other County departments and community partners. Additionally, through the establishment of the Community Experience Partnership and the recent launch of the Behavioral Health Equity Index, in collaboration with the University of California San Diego, BHS is leading the development of a tool for measuring behavioral health equity which will be used to inform program planning, siting of services, and allocation of resources in a way that supports community needs. If approved, today's actions will improve access to treatment and care for populations who are underserved by social and behavioral health resources, including individuals experiencing homelessness, individuals with justice involvement, as well as children and youth with complex behavioral health needs.
SUSTAINABILITY IMPACT STATEMENT
Today’s proposed actions to provide services that improve access to treatment and care for populations who are underserved by social and behavioral health resources would support the County of San Diego Sustainability Goal #2 to provide just and equitable access to County services, Sustainability Goal #3 to transition to a green, carbon-free economy, and Sustainability Goal #4, to protect the health and well-being. This will be accomplished by providing a wider availability and range of supportive, inclusive, and stigma-free options to those in need of behavioral health services. Services will improve the overall health of communities, reducing the demand of associated care services, and in turn increase effectiveness of care providers and lower operating costs of facilities, thus reducing emissions and waste generated within the care sector.
FISCAL IMPACT
Funds for these requests are included in the Fiscal Year (FY) 2023-25 Operational Plan in the Health and Human Services Agency (HHSA). If approved, today’s recommendations will result in approximate costs and revenue of $3.7 million in FY 2023-24 and $239.6 million in FY 2024-25. There will be no change in net General Fund cost and no additional staff years.
Recommendation #1: Authorize Competitive Solicitations
If approved, this request will result in estimated costs and revenue of $1.1 million in FY 2023-24 and $150.1 million in FY 2024-25. The funding sources are Mental Health Services Act (MHSA), Realignment, Short Doyle Medi-Cal, California Work Opportunity, and Responsibility to Kids (CalWORKS), Perinatal/Substance Abuse Block Grant, Drug Medi-Cal (DMC), and Assembly Bill 109. There will be no change in net General Fund cost and no additional staff years.
Recommendation #2: Authorize Single Source Contracts
If approved, this request will result in estimated costs and revenue of $53.4 million in FY 2024-25. The funding sources are MHSA, Realignment, and Short Doyle Medi-Cal. There will be no change in net General Fund cost and no additional staff years.
Recommendation #3: Authorize Amendments and Extend Contracts
If approved, this request will result in estimated costs and revenues of $2.5 million in FY 2023-24 and $35.6 million in FY 2024-25. The funding sources are MHSA, Realignment, Short Doyle Medi-Cal, DMC, Crisis Care Mobile Unit Grant, California Department of Social Services, and the Public Safety Group Behavioral Health Court Diversionary Grant funds. There will be no change in net General Fund cost and no additional staff years.
Recommendation #4: Execution of a Cooperative Agreement and a Revenue Agreement
If approved, this request will result in estimated costs and revenue of $0.1 million in FY 2023-24 and $0.5 million in Fiscal Year 2024-25. The funding sources are Realignment and Driving Under the Influence Program participant fees. 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 meeting on July 6, 2023, the Behavioral Health Advisory Board voted to approve these recommendations.
BACKGROUND
The County of San Diego (County) Health and Human Services Agency, Behavioral Health Services (BHS) provides a comprehensive array of community-based behavioral health services to vulnerable populations, including individuals who are experiencing homelessness, individuals with justice involvement, and children and youth with complex behavioral health conditions. Services are provided through County-operated programs as well as contracts with local public and private agencies. Approval of today’s recommended actions would authorize competitive solicitations, single source procurements, amendments to extend existing behavioral health services contracts, and execution of revenue and cooperative agreements. These recommended actions support the continuation of critical work to advance the ongoing transformation of the behavioral health continuum of care throughout San Diego County. All contracts are contingent upon the availability of funding, successful negotiations, and determination of a fair and reasonable price.
Recommendation #1: Authorize Competitive Solicitations
a. Assertive Community Treatment Services
On June 20, 2017 (13), the San Diego County Board of Supervisors (Board) authorized the procurements of Assertive Community Treatment (ACT) Services in the Central and North Central regions, as well as countywide for older adults and transition age youth (TAY). Subsequently, on November 15, 2022 (28), the Board authorized a contract term extension for these ACT programs up to June 30, 2024, and up to an additional six months, if needed. ACT programs provide intensive multidisciplinary treatment services for clients who are experiencing homelessness, who have a serious mental illness (SMI), and whose needs cannot be adequately met through a lower level of care and are deemed in the highest need based on severity of impairment. Services are provided by a multidisciplinary team countywide and include psychiatry, medication management, case management, rehabilitation and support, peer support, co-occurring treatment, supportive employment, and housing support services. Currently, BHS has 18 ACT programs, four of which are planned to be reprocured in Fiscal Year (FY) 2024-25. Local data shows that ACT services offset costs through a reduction in emergency utilization when comparing client contacts six months before and after a sustained connection to services. In calendar year 2021, utilization of emergency services witnessed a 56% reduction following ACT, going from 676 to 296 total contacts. As of June 2021, 92% of the 1,281 clients served were housed. During the same fiscal year, 77% of the 1,238 clients showed functional improvement and 74% showed clinical improvement. Additionally, 91.5% of ACT clients were connected to a primary care provider.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of four ACT programs for an Initial Term of up to one year with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
b. Behavioral Health Patient Rights Education and Advocacy Services
On November 13, 2018 (12), the Board authorized the procurement of Behavioral Health Patient Rights Education and Advocacy Services program. The program provides education and advocacy services for residents who need help accessing health care coverage, including medical and behavioral health services. Services are provided countywide and include assuring consumer access to appropriate and timely mental health and substance use programs, assisting in outpatient behavioral health beneficiary grievance and appeals resolution, and serving as a patient’s rights advocate for county mental health and substance use program recipients.
In FY 2021-22, a total of 2,228 unduplicated clients were served through Behavioral Health Patient Rights Education and Advocacy Services. The program remains connected to clients, stakeholders, and partners through over 300 virtual and in-person presentations, training, social media, and outreach events. Additionally, the program offers a hotline for assistance, referral, and general education on the availability of health services. The hotline received approximately 10,000 calls in FY 2021-22. To ensure customer satisfaction, consumers complete a satisfaction survey to report on their experience. In FY 2021-22, 91% of the 140 consumers who were surveyed responded services provided by the contractor as being good or very good. Additionally, of the 193 consumers who participated in Contractor's Health Education and Advocacy programs and workshops, 98% reported increased knowledge about the services for which they are eligible, how to access services, and how to navigate the physical and/or mental health medical services system.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of the Behavioral Health Patient Rights Education and Advocacy Services program for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
c. Supported Employment Technical Consultant Services
On November 13, 2018 (12), the Board authorized the procurement of Supported Employment Technical Consultant Services. This program provides technical expertise and consultation on countywide employment development, partnership, engagement, and funding opportunities for adults with behavioral health conditions. Services are coordinated and integrated with the BHS system of care, and operate through collaboration with behavioral health providers, regional collaboratives, local employers, public and private employment agencies, workforce partnerships, and other related stakeholders to develop new employment resources. Data shows that from FY 2014-15 to FY 2021-22, there was a 66% increase in clients with competitive employment from 3,370 unduplicated clients in FY 2014-15, to nearly 5,596 in FY 2021-22. This increased client participation may be attributed to the Supported Employment Initiative which was implemented in FY 2014-15, and the Individualized Placement & Support Model which was implemented in FY 2018-19.
BHS continues to seek out opportunities to improve the quality of life for individuals connected to behavioral health programs through supported employment. A consistent income makes it possible to secure and retain housing, increases social connectedness, and provides opportunities for a stable future. Going forward, the program will include components of adding an Individualized Placement and Support (IPS) Trainer that will assist in educating providers and will expand meetings to substance use programs in support of clients in their journey to independence and well-being.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of the Supported Employment Technical Consultant Services program for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
d. Supported Employment Continuum
On November 13, 2018 (12), the Board authorized the procurement of Supported Employment Continuum, a program that provides an array of job opportunities to help adults with SMI obtain competitive employment. Services are provided countywide and are coordinated and integrated with the BHS system of care, and operate through collaboration with behavioral health providers, regional collaboratives, local employers, public and private employment agencies, workforce partnerships, and other related stakeholders to develop new employment resources. The program uses a comprehensive approach that is community-based, client- and family- driven, and culturally competent. This program supports the County’s FY 2020-24 Five-Year Strategic Employment Plan, which outlines a clear vision for continued expansion of employment opportunities for people with behavioral health issues. In alignment with this vision the program served 153 unduplicated clients, exceeding FY 2021-22 goals.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of the Supported Employment Continuum program for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
e. Faith-Based Behavioral Health Training, Education Academy and Community Education
On November 13, 2018 (12), the Board authorized the procurement of Faith-Based Behavioral Health Training and Education Academy (FBBHEA) and Community Education. FBBHEA and Community Education curricula for Behavioral Health Services were developed to increase awareness and understanding of behavioral health issues and faith-based approaches to addressing behavioral health needs. The program serves faith leaders, their congregations, behavioral health providers, and communities, and its community education trainings facilitate behavioral health awareness and connections to resources within the North and Central regions. FBBHEA and Community Education Presentations (CEP) extend behavioral health related education into communities that may otherwise not have access to this information.
In FY 2021-22, the total participants exceeded the program goals for both FBBHEA and CEP. A total of 134 individuals participated in FBBHEA and 647 individuals participated in CEP in the North region, which exceeded the attendee goal by 12% and 116%, respectively. A total of 126 individuals participated in FBBHEA and 516 individuals participated in CEP in the Central Region, which exceeded the attendee goal by 5% and 72%, respectively.
Data from the United States Census bureau shows there are over 1,700 temples, mosques, churches, or synagogues in San Diego County. In FY 2021-22, the programs performed outreach and engagement services connecting with nearly 200 faith-based groups. If approved, the program will be expanded into four regional contracts (North, Central, East, and South regions) to improve the reach to additional faith-based groups.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of the Faith-Based Behavioral Health Training and Education Academy, and Community Education program for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
f. Faith-Based Wellness and Mental Health In-Reach Ministry
On November 13, 2018 (12), the Board authorized the procurement of Faith Based Wellness and Mental Health In-Reach Ministry. Subsequently on November 16, 2021 (5), the Board authorized a contract term extension of this program up to June 30, 2024, and up to an additional six months, if needed. The Project In-Reach Ministry program provides services to at-risk and treatment-resistant individuals identified by detention facility staff. In-reach services aim to educate detention staff and support the successful transition and reintegration of individuals from jail to the community. The target population includes incarcerated TAY and adult African American or Latino individuals with SMI. Services are provided countywide, are consistent with pastoral counseling and individuals’ faith, and include spiritual support, mental and physical health wellness, education about community resources, and counseling on the impact and effects of untreated mental illness, co-occurring conditions, and trauma. In FY 2021-22, the program served a total of 239 unduplicated clients and 65% of these clients were linked to services at discharge.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of Project In-Reach program for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
g. Jail In-Reach
On January 7, 2014 (9), the Board authorized the procurement of Jail In-Reach Services to provide engagement for incarcerated adults, who have or are at risk of psychological disorders and /or substance use conditions while in detention, and to prepare them for community reentry. This program provides services to at-risk and treatment-resistant individuals identified by detention facility staff and aim to educate detention staff and support the successful transition and reintegration of individuals from jail to the community, with a focus on reducing recidivism by improving outcomes among key areas of functioning: health, housing, mental health, prosocial, substance use, family-wellness, and employment. The target population is incarcerated TAY and adult African American or Latino individuals with SMI. Services are provided countywide and include screening, case management, group and individual counseling and crisis intervention while in detention, and case management in the community to ensure individuals are linked to appropriate services. In FY 2021-22, the program served a total of 242 unduplicated clients of whom 67% were linked to services at discharge.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of Jail In-Reach program for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
h. Incredible Families
On June 19, 2018 (9), the Board authorized the procurement of Incredible Families program, which provides parenting support group and outpatient mental health treatment services for children and youth ages 2 to 14 and their families involved with the County Department of Child & Family Well-Being (CFWB), promoting the reunification of children with their families. This program receives all referrals from, and supports clients through collaboration with CFWB. Services are provided countywide and include psychotherapy for individuals and families, psychiatric services, case management, rehabilitative services, intensive care coordination, intensive home-based services, collateral crisis intervention services, therapeutic family visitation, and peer support services.
The Incredible Years parenting group component of the program supports parents with developing emotional engagement and healthy skills for parenting their children. In FY 2021-22, the program served a total of 64 unduplicated clients, of whom 67% were provided therapeutic family visitation. Additionally, of the 34 families enrolled in the Incredible Years parenting group, 53% completed all group sessions. Moreover, all 50 discharged clients avoided psychiatric hospitalization or re-hospitalization.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of the Incredible Families program for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
i. Multicultural Community Counseling
On November 15, 2022 (28), the Board authorized a contract term extension of the Multicultural Community Counseling (MCC) program up to June 30, 2024, and up to an additional six months, if needed. The MCC program is an outpatient behavioral health program that provides services to Asian/Pacific Islander and Latino children and youth up to age 21. Services are provided countywide and include individual, group, and family therapy, care coordination, case management, rehabilitative services, crisis intervention, medication services, and outreach and engagement. These services support the need for cultural and specific outpatient behavioral health services and case management needs of youth and their families. Services are available in multiple languages including Tagalog, Vietnamese, Spanish, Mandarin, and Korean, and are provided both in person at clients’ homes, schools, community sites, and clinic, as well as via telehealth. In FY 2021-22, the program served a total of 198 unduplicated clients. All 87 clients who were discharged avoided psychiatric hospitalization and transitioned to, or remained in a less restrictive, educational setting.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of the MCC program for an Initial Term of up to one year, with up to four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
j. Intensive Case Management Wraparound Services
On February 9, 2018, the Family First Prevention and Services Act, was signed into law. The Qualified Residential Treatment Programs requirements include the provision of discharge planning and family-based aftercare supports, including wraparound services, for at least six months post-discharge. Wraparound services have proven highly successful in facilitating stability and permanency for the highest need youth and their families. On June 19, 2018 (9), the Board authorized the procurement of Intensive Case Management Wraparound Services program for Youth and Families Involved with CFWB. The program offers team based intensive and individualized case management to children and youth involved in the Child Welfare and Probation systems, leveraging both formal and informal supports. The services are designed to maximize families’ capacity to meet youths’ needs and, in turn, reduce the frequency of hospitalizations and support transitions to lower levels of care from a congregate care setting to a permanent home or home-like setting. Services are provided countywide and include assessment, crisis intervention, case management and rehabilitative services, intensive care coordination, intensive home-based services, medication management, and individual therapy.
In FY 2021-22, the program served a total of 260 unduplicated clients. Of the 143 clients living in a home or home-based settings, 93% avoided placement into higher level of care at discharge. Additionally, 81% of the 16 clients residing in residential settings returned home or to a home-based setting. Furthermore, of the 61 probation-involved clients, 74% avoided a probation violation charge while 79% avoided a new charge while in treatment.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of the Intensive Case Management Wraparound program for an Initial Term of up to one year, with four 1-year Options and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
k. Early Intervention for Prevention of Psychosis Program
On January 7, 2014 (9), the Board authorized the procurement of the Early Intervention for Prevention of Psychosis Program. Subsequently on November 16, 2021 (5), the Board authorized a contract term extension of this program up to June 30, 2024, and up to an additional six months, if needed. This program provides prevention through public outreach and education about psychosis. Prevention and Early Intervention (PEI) programs are designed to prevent the onset of mental illness or provide early intervention to decrease severity of symptoms, with a special focus on reducing the stigma associated with mental illness, preventing suicide, and addressing the early signs of psychosis. The Early Intervention for Prevention of Psychosis program services are provided countywide to children and TAY, ages 10 to 25, who have emerging early symptoms of psychosis. This program has three service components: 1) Prevention through public education; 2) Early Intervention through screening potentially at-risk youth; and 3) Intensive Treatment with treatment of youth who are identified as at risk and their families.
The Early Intervention for Prevention of Psychosis program measures improvements in ‘Functional’ and ‘Clinical’ status. ‘Functional Status’ measures how much a client's symptoms hinder them from completing tasks that they would like to or need to do. ‘Clinical Status’ measures the last time a client had a relapse of symptoms or when their symptoms worsened. In FY 2021-22, the PEI Mental Health Service Act (MHSA) program served 207 unduplicated clients, while the First Episode Psychosis Mental Health Block Grant program served 103 unduplicated clients. Of the 310 total clients served, 90.5% showed same or improved Functional Status and 90% showed same or improved Clinical Status. Additionally, 324 clients were screened and 24 Outreach and Educational presentations were provided to community leaders during FY 2021-22.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of the Early Intervention for Prevention of Psychosis Program for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
l. Community Harm Reduction Team
On January 26, 2021 (11), the Board authorized the procurement of the Community Harm Reduction Team (C-HRT). C-HRTs provide street outreach and engagement in the East Village and Midway areas of the City of San Diego to adults over the age of 18 who are experiencing homelessness, have a chronic substance use condition, and are resistant to services. Services include just in time specialty services, connection to behavioral health resources, Medication Assisted Treatment (MAT), and designated housing including short term shelter and Safe Haven housing for difficult-to-engage clients with behavioral health conditions. Just in time services are designed to remove barriers that cause delays in access to services including transportation, joining individual to appointments, and ensuring connections to ongoing treatment or services. Together, these services support individuals’ journey to wellness, stability, and access to permanent supportive housing.
In FY 2021-22, the program served a total of 135 unduplicated clients, of whom 43% were served through street outreach, 32% were served in the designated C-HRT shelter, and 24% were discharged. Over 20% of those discharged during FY 2021-22 went to permanent housing.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of the C-HRT for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
m. Support Services for Women Experiencing Homelessness
On November 13, 2018 (12), the Board authorized the procurement of Behavioral Health Education for Women Experiencing Homelessness program. This program supports women over the age of 18 who are experiencing homelessness and behavioral health conditions. This program works with managed care plans for opportunities funded by California Advancing and Innovating Medi-Cal (CalAIM) that serve individuals with behavioral health issues to promote a systematic approach to coordinated care with Behavioral Health contracted services. The program provides assistance tailored to the needs of participants through linkages with community-based resources to address mental health, physical health, and substance use conditions in a safe and trauma informed environment. Services are provided in Central region and include access to showers, mail and phone services, case management, educational groups, and supportive services. This program facilitates weekly meetings for program participants connected to recovery planning, relapse prevention, self-help, and community resources. The overall program outcomes are associated with developing goals to improve quality of life, level of functioning, and connection to housing. Research shows that the burden of homelessness on women creates multiple challenges including vulnerability to victimization, limited options for safe locations to meet personal needs, and connection to resources, highlighting the importance of this program. In FY 2021-22, the program served a total of 210 unduplicated clients.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of the Behavioral Health Education for Women Experiencing Homelessness program for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
n. Adult Substance Use Outpatient Program
On September 23, 2014 (9), the Board authorized the procurement of Adult Substance Use Outpatient Programs. Subsequently on March 27, 2018 (2) and December 11, 2018 (13), the Board authorized negotiations to amend existing contracts to reflect changes to services and authorized single source procurements for a term of up to one year, with up to four option years, and up to an additional six months. Additionally, on November 16, 2021 (5), the Board authorized term extension of existing contracts up to June 30, 2024, and up to an additional six months, if needed. Adult Substance Use Outpatient Programs provide treatment, recovery, and ancillary services to TAY ages 18 to 21, adults ages 18 years and older, and older adults with substance use conditions including those with co-occurring mental health needs. Services are provided countywide and incorporate evidence-based treatment and recovery approaches, including outpatient withdrawal management, intensive outpatient substance use treatment, case management, connection to MAT, recovery services, and client support in attaining the appropriate level of care, employment, and stable housing. This includes American Society of Addiction Medicine (ASAM) outpatient treatment and intensive outpatient services, which are critical components in the substance use continuum of care within San Diego County.
The five Adult Substance Use Outpatient Treatment programs that are being re-procured as part of today’s action served a total of 730 unduplicated clients in FY 2021-22. Of those, 51 were experiencing homelessness at intake, over 90% of whom were housed at the end of treatment, highlighting the programs’ success in supporting clients in achieving housing stability. Furthermore, of the 274 clients who completed treatment during FY 2021-22, 82% were enrolled in an eligibility program or in a formal educational setting or were employed in a structured employment preparation program at conclusion of treatment. Despite these accomplishments, the opioid epidemic and rise in fentanyl deaths continues to emphasize the need to enhance substance use outpatient services and MAT in our behavioral health continuum of care to address community needs. The San Diego County Medical Examiner reported 33 fentanyl deaths in 2016, and since then the number of deaths has been on the rise, exceeding 750 in 2022.
Today’s action requests the Board authorize competitive solicitations for the re-procurement of the five Substance Use Outpatient Treatment Programs for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
o. Adult Substance Use Residential Program
On March 27, 2018 (2) and December 11, 2018 (13), the Board authorized single source contracts of the Adult Substance Use Residential Programs. These programs provide 24-hour, non-medical, residential substance use treatment, withdrawal management, recovery, and ancillary services to adults over the age of 18 with behavioral health conditions. Services are comprehensive, preventive, rehabilitative, and therapeutic behavioral health care delivered in the least restrictive environment and in the most effective mode based on the criteria set out by ASAM, and may include clinical assessments for substance use and mental health conditions, care coordination support transitions in the behavioral health system when client needs exceed services available through the program. Programs are designed to provide clients access to timely care and ultimately improve their quality of life. Services are provided countywide, however, the programs located in the Central, North Central, and East regions are due for re-procurement; there are also existing programs in the North and South regions not yet due for re-procurement. In FY 2021-22, the Adult Substance Use Residential Programs included in today’s action served a total of 1,912 unduplicated clients, 99% of whom had no new arrests. Of the 1,102 clients who were experiencing homelessness upon admission and discharged as planned, there was an over 80% decrease in homelessness as clients were placed in dependent and independent housing.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of Adult Substance Use Residential Programs for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding. If approved, it is anticipated that procurement for Substance Use Residential Treatment programs will result in multiple contract awards.
p. Perinatal Substance Use Residential Program
On March 27, 2018 (2), the Board authorized the implementation of Drug Medi-Cal Organized Delivery System (DMC-ODS) to improve care for those struggling with substance use and to enhance the system of care available to San Diego County residents. The Board’s action authorized single source procurements of three Perinatal Substance Use Residential Programs. Subsequently, on June 4, 2019 (10), the Board authorized the single source procurement of an additional Perinatal Substance Use Residential Program in the Central Region. Subsequently, on November 15, 2022 (28), the Board authorized a contract term extension of the four programs up to June 30, 2024, and up to an additional six months, if needed. Services are provided countywide and include screening, care coordination, residential substance use treatment, recovery, and ancillary services to pregnant or parenting women with substance use conditions, including co-occurring mental health conditions. Additionally, these programs provide parenting classes, childcare services, peer support services, and clinician services for children. Perinatal Substance Use Residential treatment services fulfill DHCS’ requirement for services that adhere to guidelines for treatment of pregnant and parenting women seeking or referred to substance use treatment.
In FY 21-22, a total of 1,137 unduplicated clients were served by Perinatal Substance Use Residential Programs. Of the 391 clients who completed treatment for 31 or more days, 99% had no new arrests, 86% were employed and/or enrolled in a formal education setting, and 96% were referred to outpatient services. Of the 290 clients who were experiencing homelessness at intake, 86% were housed at the conclusion of treatment phase. Furthermore, 96% of babies born to mothers in treatment were born free of exposure to illicit substances.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of Perinatal Substance Use Residential Programs for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
q. Adolescent Substance Use Residential Program
On March 27, 2018 (2), the Board authorized the single source procurement of the Adolescent Substance Use Residential Program. Subsequently, on November 15, 2022 (28), the Board authorized a term extension of this contract up to June 30, 2024, and up to an additional six months, if needed. The Adolescent Substance Use Residential Program provides 24-hour, non-medical residential substance use treatment, recovery, and ancillary services to adolescents ages 12 to 17 with behavioral health conditions. Services are provided countywide and include individual or group treatment, case management, peer support, education groups, as well as prosocial activities that are designed to encourage and promote positive behaviors, such as volunteer work. When applicable, program staff assist clients in complying with court mandates and probation requirements. This program ensures access to quality substance use treatment services for adolescents in accordance with DMC-ODS and fulfills DHCS’ requirements by adhering to Adolescent substance use best practices for treatment for adolescents seeking or referred to substance use treatment. In FY 2021-22, the program served a total of 99 unduplicated clients. Of the 53 discharged clients who completed treatment for 31 or more days, 100% had no new arrests, 92% were employed and/or enrolled in a formal education setting, and 100% were referred to outpatient services.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of Adolescent Substance Use Residential Program for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
r. Adult Substance Use Outpatient Program for Alcohol Use
On November 16, 2021 (5), the Board authorized a contract term extension of the Adult Substance Use Outpatient Program for Alcohol Use, formerly known as Serial Inebriate Program, up to June 30, 2024, with an additional six months, if needed. This program primarily operates in the Central region and provides outpatient substance use treatment, recovery, and ancillary services to adults over the age of 18 with a primary alcohol use condition, but may include co-occurring mental health and other substance use conditions. The program provides screenings, assessments, substance use group and individual counseling, intensive case management, peer support, and recovery services at a trauma informed care facility that focuses on whole person wellness and utilizes evidenced base practices. Additionally, the program supports the County’s efforts to address homelessness by serving as transitional housing for clients while engaged in treatment for up to two years. As a collaborative effort to address chronic alcohol use, referrals to the program are accepted from law enforcement, probation, the courts, emergency medical services, other behavioral health treatment providers, and hospitals.
In FY 2021-22, the program received 215 referrals and admitted 95 clients. A total of 12 clients who completed at least 31 days of treatment were discharged during FY 2021-22. Among those discharges, 11 clients were experiencing homelessness at intake, 100% of whom had secured stable housing at discharge. Additionally, 11 clients had achieved self-sufficiency through employment, schooling, or a public benefit program at the time of discharge. Lastly, 10 discharged clients were enrolled in Recovery Services.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of the Adult Substance Use Outpatient Program for Alcohol Use for an Initial Term of up to one year, with four 1- year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
s. Peer Support Services
On November 13, 2018 (12), the Board authorized the procurement of Peer Support Services. This program serves adults over the age of 18 with SMI, who in addition to needing to use hospital and/or crisis residential services, have a limited social support network and are most likely to not be effectively connected with relevant services. Through the peer support services programs, appropriate connections are made with regional behavioral health resources, which lead to improved access to care and reduce unnecessary acute care utilization. Services are provided countywide and include coaching, incorporating shared decision-making, and active social supports.
In FY 2021-22, there were 265 unique admissions to Central region hospitals, of whom 96% had a decrease in 30-day psychiatric hospitalization readmissions and 94% had a decrease in 30-day crisis residential facility readmissions. Within three months of enrollment, 67% of admitted individuals were linked to a social support/recovery network, and 80% demonstrated an improved level of recovery at discharge as measured by Milestones of Recovery Scale.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of Peer Support Services for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
t. Behavioral Health Services for AB 109 Clients
On January 7, 2014 (9), the Board authorized the procurement of Behavioral Health Services for AB 109 Clients. Subsequently on November 15, 2022 (28), the Board authorized a term extension of this contract up to December 31, 2023, and up to an additional six months, if needed. The Behavioral Health Services for AB 109 Clients program provides comprehensive mental health services to individuals referred by the Probation Department and under supervision as AB 109 offenders. This includes individuals on post-release community supervision and mandatory supervision. Services are provided in North Coastal and Central regions of the county and include comprehensive mental health services, medication management, strengths-based case management, assertive outreach, assertive research, cognitive-behavioral individual and group therapy, transportation assistance, linkage and referrals to community-based organizations, education, employment, and housing. This program functions to increase access and connectivity between the justice system and behavioral health to ensure clients are receiving the appropriate level of care through best practices that improve wellness and reduce recidivism. In FY 2021-22, the program served a total of 343 unduplicated clients.
Today’s action requests the Board to authorize a competitive solicitation for the re-procurement of the Behavioral Health Services for AB 109 Clients program for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding.
u. Intensive Outpatient Program and Partial Hospitalization Program
Intensive Outpatient Program (IOP) and Partial Hospitalization Program (PHP) are non-24-hour, hospital-based or community-based treatment programs. Both programs are designed to provide diagnostic and clinical treatment services to children and youth under the age of 21 with specialty mental health needs, inclusive of substance use co-occurring needs, in a structured and therapeutic environment. IOP programming is traditionally offered multiple days a week after school hours, while PHP offers a full day curriculum during weekdays. Services include individual, group, and family therapy, psychiatric evaluation, medication management, peer support and/or recovery-oriented services.
In February 2022, the Centers for Disease Control and Prevention reported that in 2020, suicide was the second leading cause of death among children ages 10 to 14. In California, over 60% of youth with depression did not receive treatment in 2022. In response to this urgent need, Governor Newsom implemented the Master Plan for Kid’s Mental Health, which initiated a transformation of California’s behavioral health infrastructure with a special focus on expanding access to community-based services from prevention through treatment and recovery. IOP and PHP are critical components of the continuum of care that are currently not available in the San Diego County public system, and are critical to the County’s efforts to respond to the increased need for intensive mental health services. If approved, today’s action would yield critical alternatives to higher levels of care as well as step-down for children and youth who have been discharged and are returning home from psychiatric inpatient or residential stays.
Today’s action requests the Board authorize competitive solicitations for the procurement of the Intensive Outpatient Program and Partial Hospitalization Program for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed for each program, and to amend contracts as needed to reflect changes in services and funding.
Recommendation #2: Authorize Single Source Contracts
a. Electroconvulsive Therapy Services
On October 4, 2016 (1), the Board authorized single source contracts for Electroconvulsive Therapy (ECT) services with Sharp Grossmont Hospital and Sharp Mesa Vista Hospital, and increased funding for the program. Subsequently, on November 16, 2021 (5), the Board authorized a single source contract for ECT services with Sharp Mesa Vista Hospital and a new single source contract with University of California San Diego. ECT is considered a specialty mental health service that is used to treat individuals with SMI who have been unresponsive to other forms of treatment. ECT services can be provided in outpatient or inpatient settings when medically justified and legally permissible.
Today’s action requests the Board authorize a single source contract with Sharp Grossmont Hospital to provide ECT services for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding. This program qualifies for a single source contract to provide these services based on the Board Policy A-87 Competitive Procurement, Section 1D-3: The procurement is for services from a provider with unique knowledge, skill, or ability not available from other sources. Since 2003, there has been ongoing efforts to identify hospitals that are willing and able to provide this service for Medi-Cal beneficiaries in San Diego County. There are limited providers able to offer ECT, which can be administered only at licensed behavioral health facilities with specialized equipment and by qualified staff, including an anesthesiologist and a psychiatrist.
b. Medi-Cal Managed Care Psychiatric Inpatient Hospital Services
On November 13, 2018 (12), the Board authorized single source contracts for Medi-Cal Managed Care Psychiatric Inpatient program services. This program provides psychiatric inpatient hospital services to adults over the age of 18, as well as older adults with acute symptoms who need 24-hour observation and intensive treatment. The program provides specialized acute inpatient services countywide.
Today’s action requests the Board authorize single source contracts with Regents of the University of California San Diego and Prime Healthcare Paradise Valley Hospital for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding. This program qualifies for a single source contract based on the Board Policy A-87 Competitive Procurement, Section 1D-3: The procurement is for services from a provider with unique knowledge, skill, or ability not available from other sources. Regents of the University of California San Diego and Paradise Valley Hospital provide psychiatric inpatient hospital services to eligible adults and older adults who experience a psychiatric emergency and require acute inpatient services to stabilize and ensure their safety and the safety of others. Medi-Cal Managed Care Psychiatric Inpatient facilities offer a secure environment where adults can stabilize and establish an aftercare plan prior to discharge. The acute care provided at such facilities is a critical component of San Diego County’s behavioral health continuum of care.
c. Skilled Nursing Facility
On June 20, 2017 (13), the Board authorized the execution of a single source contract of a Skilled Nursing Facility (SNF) for Adults with Behavioral Health Conditions with Vista Woods Health Association LLC. Subsequently, on November 15, 2022 (28), the Board authorized extensions to the contract term for this facility up to June 30, 2024, and up to additional six months, if needed. Additionally, on November 13, 2018 (12), the Board authorized a single source contract of a 24-hour SNF with Special Treatment Program Services (STP) as well as 24-hour Medical, Nursing and Rehabilitative Services with GHC of Lakeside LLC.
Today’s action requests the Board authorize single source contracts for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding. The SNF provides specialized mental health services utilizing its expertise, competencies, capabilities, and resources. The following programs qualify for a single source contract to provide the SNF specialized services based on the Board Policy A-87 Competitive Procurement, Section 1 D-3: The procurement is for services from a provider with unique knowledge, skill, or ability not available from other sources:
i. Skilled Nursing Facility for Adults with Behavioral Health Conditions
The Vista Woods Health Association LLC facility is a 24-hour Mental Health Rehabilitation Center providing augmented services for clients needing additional psychiatric support. While there are other SNF’s in San Diego County that may be able to provide augmented services for clients needing psychiatric support, the Vista Woods Health Association LLC is the only facility which has a specialized neurobehavioral unit for adults diagnosed with neurocognitive impairment and traumatic brain injury. This facility provides specialized mental health services countywide utilizing its expertise, competencies, capabilities, and resources. In FY 2021-22, this facility served a total of 25 unduplicated clients; all clients served have been discharged to a lower level of care and none have returned to the facility after discharge.
ii. Skilled Nursing Facility with Special Treatment Program
The GHC of Lakeside LLC is the only licensed SNF with STP facility in San Diego County, designed to serve clients who have a severe psychiatric impairment and whose adaptive functioning is moderately impaired. Through structured programs, this secured 24-hour facility provides care for clients over the age of 18 years with SMI who require. Services are provided countywide and include pre-vocational preparation and pre-release planning services, as well as therapeutic services to mentally ill persons having special needs in one or more of the following areas: self-help skills, behavioral adjustment, and interpersonal relationships. In FY 2021-22, this facility served a total of 123 unduplicated clients.
d. Short Term Residential Therapeutic Program
On October 17, 2000 (1), the Board authorized the implementation of the Children’s Mental Health Initiative that allowed for an expanded continuum of comprehensive mental health care for children, adolescents, and their families. This action authorized the execution of new contracts for mental health services to children placed in State-licensed residential care programs. On January 24, 2017 (2), the Board authorized single source contracts for residential services inclusive of STRTP. STRTPs are residential facilities that provide an integrated program of specialized and intensive care and supervision, services, and supports, Specialty Mental Health Services (SMHS), in addition to short-term, 24-hour care and supervision to children experiencing mental health crisis. The County CFWB has the oversight of these facilities and establishes STRTP contracts for care and supervision while BHS establishes companion contracts for the provision of the SMHS. This program provides therapeutic behavioral health services for children and youth ages 6 to 21 with behavioral health conditions as a result of trauma. Services are provided countywide and include individual, family, and group psychotherapy, medication management, case management, rehabilitative services, Intensive Care Coordination, Intensive Home-Based Services, collateral support services, and crisis intervention services. All local STRTPs with an active contract and in good standing with CFWB obtain the ancillary Behavioral Health Services contract for SMHS. In FY 21-22, these STRTPs served a total of 372 unduplicated clients, of whom 217 were discharged. Among those discharged, 41% transitioned to a lower level of care and 85% avoided psychiatric hospitalization or re-hospitalization.
Today’s action requests the Board authorize a single source contract with New Alternatives Inc. (Kenora) for STRTP for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend the contract as needed to reflect changes in services and funding. This qualifies for a single source contract based on Board Policy A-87 Competitive Procurement, Section 1D-6 Continuity: The procurement is for goods and/or services where continuity of providers will provide efficiency or critical knowledge, and other providers of the goods and/or services cannot provide similar efficiencies or critical knowledge. If approved, today’s action ensures efficient continuation of SMHS.
e. School-Based Outpatient Behavioral Health Services
On February 24, 2009 (8), the Board authorized the continuation of school-based contracts beyond their expiration dates based on school district choice. Subsequently, on January 24, 2017 (2), the Board authorized the single source procurement of School-Based Outpatient Behavioral Health Services program. The program provides culturally competent outpatient behavioral health services at designated schools, home, community, or office/clinic locations, as well as via telehealth. Services are provided countywide and include individual, group, and family therapy, case management, rehabilitative services, crisis intervention, medication management, as well as outreach and engagement to children and youth under the age of 21, and their families. The implementation of school-based mental health services began in 1995 with leadership oversight by the Board School Subcommittee. Beginning in 2002, the Board began awarding and extending school-based contracts through a single source process. The County has worked extensively with elementary, middle, and high schools, existing and potential providers, and consumers to create an infrastructure that ensures that entities selected to provide services on school campuses are the choice of the school districts. Over the years, this partnership has led to a system of care that emphasizes accessibility of behavioral health services at school campuses, with services tailored to the needs of the students and schools. Currently, BHS has 28 school-based contracts, 13 of which (Attachment A) will be renewed as part of today’s actions. In FY 21-22, school-based programs served a total of 7,362 unduplicated clients. Of 4,777 discharged clients, 96% avoided psychiatric hospitalization or re-hospitalization. Additionally, over 71% of clients whose episode lasted 30 days or longer were referred to a prosocial activity at discharge.
Today’s action requests the Board authorize single source contracts with existing contractors (Attachment A) for school-based behavioral health services for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed, and to amend contracts as needed to reflect changes in services and funding. These programs qualify for single source contracts to provide specialty mental health services based on Board Policy A-87 Competitive Procurement, Section 1D-6 Continuity: The procurement is for goods and/or services where continuity of services will provide efficiency or critical knowledge, and other providers of the good/ and/or services cannot provide similar efficiencies or critical knowledge. This collaboration and partnership between BHS and school districts has resulted in significant expansion of behavioral health school-based services where the contractors possess expertise, competencies, resources, and a partnership with the school that cannot be replicated. If approved, this ensures efficient continuation of school-based behavioral health services.
Recommendation #3: Authorization to Amend to Extend
a. Placement Stabilization Services at Polinsky Children’s Center (Contract #556401)
On October 4, 2016 (1), the Board authorized the procurement of Placement Stabilization Services at Polinsky Children’s Center (PCC). In collaboration with CFWB, this program supports the mental health needs of children and youth placed at PCC after removal from parent, guardian, caregiver, or other current living situation. This program is designed to identify mental health needs of children and youth ages 6 to 17 at PCC to ensure proper interventions are in place through a comprehensive behavioral health assessment. Services include assessment sessions, treatment planning, individual therapy, group therapy, rehabilitation services, case management, and crisis intervention. Most children and youth placed at PCC have experienced some form of trauma due to chronic abuse, exposure to violence, or recent placement disruption. The Placement Stabilization Services program identifies and supports emotional and behavioral needs of children and youth in order to enhance stability. In FY 2021-22, the program served a total of 137 unduplicated clients. Of the 135 clients that were discharged, 33% received group therapy services.
Today’s action requests the Board authorize an extension of the current contract with New Alternatives, Inc. for the Placement Stabilization Services at Polinsky Children’s Center up to December 31, 2024, and up to an additional six months, if needed.
b. Breaking Down Barriers Initiative (Contract #559599)
Pursuant to Admin Code 401, the County’s Director of the Department of Purchasing and Contracting authorized the procurement of the Breaking Down Barriers program on February 1, 2019. The Breaking Down Barriers program aims to reduce mental health stigma. The program includes providing outreach, engagement, and education to persons who are members of unserved and underserved populations from culturally diverse populations. The program also creates effective collaborations with other agencies, community groups, client and family member organizations, and other stakeholders to support the program’s mental health stigma and discrimination reduction campaign. The target populations of this program include, but are not limited to Latino, African American, LGBTQ+, refugees, Middle Eastern, Asian/Pacific-Islander, and Native American. Services are provided countywide and include educational workshops and events, discussions of mental health, as well as outreach to unserved and underserved populations and linking them to appropriate mental health services and other resources. The program provides cultural humility/competency training to community members and providers who work with target populations. Academic research and program utilization data have shown that individuals from diverse communities often face unique challenges when accessing mental health services, including stigma, cultural barriers, and a lack of awareness of available resources. The program's workshops, events, and outreach efforts aim to reduce such barriers and improve the overall well-being of individuals in underserved communities.
In FY 2021-22, the program provided prevention/early intervention services to 6,340 participants. Additionally, a total of 232 community presentations and 118 group sessions provided, exceeding program goals. Among participants served by the program, 96% demonstrated an increased awareness of mental health resources, knowledge of factors leading to mental health stigma, and strategies to reduce and prevent mental health stigma. Today’s action requests the Board authorize an extension of the current contract with Jewish Family Service for Breaking Down Barriers Services up to December 31, 2024.
c. Behavioral Health Administrative Services Organization dba Optum (Contract #553848)
On August 4, 2015 (4), the Board authorized the procurement of the Behavioral Health Administrative Services Organization (ASO). The County Health and Human Services Agency has ongoing and evolving needs for the ASO program to support healthcare services, including specialty Pre-Paid Inpatient Plan (PIHP) requirements. Services include provision of Clinical Management Services to include a 24/7 Behavioral Health Access and Crisis Line (ACL), and utilization management activities, management of the BHS contracted Fee-for-Service Provider Network, provision of claims and billing support for in and out of network providers and facilities; provision of Management Information System support services, and provision of Credentialing and Medi-Cal Provider Enrollment Services. Today’s action requests the Board authorize an extension of the current contract with United Behavioral Health for Optum Health Services up to June 30, 2027, and up to and additional six months, if needed. As local needs regarding CalAIM implementation are still evolving, approval of today’s recommended action would allow for support in areas of specialty health plan and DMC-ODS requirements to align with payment reform and new medical necessity and documentation standards; and provision of centralized processes supporting health plan operations. Additionally, an extension of the contract term would allow for continued infrastructure and staffing of ongoing essential projects related to the mental health plan electronic health record and technological updates and expansion of the 9-8-8 Suicide and Crisis Lifeline.
d. Behavioral Health Collaborative Court (Contract #551670)
On November 16, 2021 (5), the Board authorized an extension to the contract term for Behavioral Health Collaborative Court. Behavioral Health Collaborative Court is a Full-Service Partnership (FSP) and ACT team that provides clinical case management and mental health, substance-induced psychiatric disorder rehabilitation treatment, and recovery services to adults 18 years and older who are experiencing SMI. Participants must be referred via the San Diego County Superior Court. Services are provided countywide and include intensive court services and community supervision by the Superior Court and Probation Department, as well as mental health and co-occurring treatment services, including medication prescription and management, case management, and support in attaining stable housing and employment. Modeling this program based on the collaborative court has shown effectiveness in increasing success and decreasing recidivism as participants transition from custody to community. The program helps participants effectively manage SMI and co-occurring conditions, while preventing future criminal activity and reducing the burden and costs of repeatedly processing individuals with low-level, non-violent offenses through the nation’s courts, jails, and prisons. In FY 2021-22, this program served 142 unique clients, of whom 76% showed improvement in their functional status and 48% showed improvement in their clinical status. Today’s action requests the Board authorize an extension of the current contract for Behavioral Health Collaborative Court up to June 30, 2024, and up to an additional six months if needed.
Recommendation #4: Execute Cooperative and Revenue Agreements
a. Department of Rehabilitation Cooperative Agreement
On January 26, 2021 (11), the Board authorized the renewal of the Cooperative Agreement with the State Department of Rehabilitation (DOR). This agreement provides vocational services for adults over the age of 18 with SMI in achieving placement in competitive employment. Services are provided countywide through a contracted provider and include client assessment, short-term support services, and employment services. In FY 2021-22, the IPS model was implemented to support the BHS Supportive Employment Strategic Plan. In FY 2021-22, the program served a total of 153 unduplicated clients, of whom 71 individuals enrolled into the employment services program, 81 received employment preparation, 63 received support for job development and placement, and 27 received job placement.
Today’s action requests the Board authorize execution of a revenue agreement with DOR for the employment services program for the period of July 1, 2024, through June 30, 2029, with an increase in revenue match dollars not to exceed $0.4 million annually, and any amendments thereto, and future years’ Agreements and amendments, provided terms, conditions, program services and funding are not materially impacted or altered. The current annual County cost for this program is $240,948, a 33% percent revenue match that leverages State funding of $473,631.
b. Driving Under the Influence Program
On October 19, 1999 (4), the Board authorized the extension of revenue agreements with the existing Driving Under the Influence (DUI) providers to continue each revenue agreement for as long as contracted provider is licensed by DHCS to provide DUI program services. The DUI programs are alcohol and other drug education and counseling programs for convicted first and multiple offenders. The programs are State regulated and licensed, and legislatively mandated for persons convicted of driving under the influence of alcohol or drugs. The program goals are to reduce the incidence of DUI, DUI recidivism, and DUI-related crashes, injuries, and fatalities which are consistent with the Board's emphasis on addressing public health and public safety impacts of substance use and misuse. Under State law, the County is responsible for monitoring the DUI program and ensuring that providers comply with all State licensing requirements and remain fiscally viable, avoiding any lapse in service. The cost of the programs, including the County's role in administering and monitoring revenue agreements with State-licensed providers, is funded entirely by DUI program participant fees collected by the providers. The County may assess an amount not to exceed five percent of gross program revenue per year for the administration and monitoring of the programs per Title 9 Regulations. The current County revenue for the existing three DUI programs is 5% of gross DUI program revenue, approximately $270,000 annually.
Today’s action requests the Board authorize the increase of licensed DUI programs in San Diego County from three to four programs, with a new program to be in the North Inland region. Implementation of this additional program would improve availability of DUI program services in the region, as the former program in that region ended in 2021. Through competitive selection, the County will recommend a provider for licensing to DHCS, and subsequently enter into a Revenue Agreement with the DHCS Licensed Program. Today’s action also requests authorization to amend the Revenue Agreement, as required, for changes in services and funding, subject to approval of the Agency Director, Health and Human Services Agency.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed actions support the County of San Diego’s (County) 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
Interim Chief Administrative Officer
ATTACHMENT(S)
Attachment A - Behavioral Health Services List of Single Source Contracts