|
DATE: |
October 22, 2024 |
27 |
SUBJECT
Title
AUTHORIZE COMPETITIVE SOLICITATIONS, SINGLE SOURCE PROCUREMENTS, AMENDMENTS TO EXTEND EXISTING CONTRACTS, AND ACCEPTANCE OF MENTAL HEALTH STUDENT SERVICES ACT GRANT FUNDS FROM THE MENTAL HEALTH SERVICES OVERSIGHT AND ACCOUNTABILITY COMMISSION (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 and 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.
If approved, today’s action would authorize competitive solicitations, single source procurements, amendments to extend existing contracts, and acceptance of Mental Health Student Services Act grant funds from the Mental Health Services Oversight and Accountability Commission. These actions are designed to sustain critical behavioral health services, with the goal of building a better service delivery system for the San Diego region. Today’s actions support the continuation of critical work to advance the behavioral health continuum of care throughout the San Diego region.
Today’s action supports the County 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 Board Policy A-87, Competitive Procurement, and Section 401, Article XXIII of the County Administrative Code, approve and authorize the Director, Department of Purchasing and Contracting, to issue competitive solicitations for each of the 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 Deputy Chief Administrative Officer, Health and Human Services Agency.
a. 24-hour Mental Health Rehabilitation Centers
b. Locum Tenens Services
c. Children and Youth Crisis Stabilization Unit
d. Medi-Cal Training and Technical Assistance for Community-Based Behavioral Health Providers
2. In accordance with Board Policy A-87, Competitive Procurement, and Administrative Code Section 401, approve and authorize the Director, Department of Purchasing and Contracting, to enter into negotiations for each of the behavioral health services listed below and subject to successful negotiations and a determination of a fair and reasonable price, award 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 the contracts to reflect changes in program, funding or service requirements, subject to the availability of funds and the approval of the Deputy Chief Administrative Officer, Health and Human Services Agency.
a. Adult Substance Use Outpatient Program for Alcohol Use (Mental Health Systems, Inc.)
b. School-Based Outpatient Behavioral Health Services (SBCS Corp.)
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 determination of a fair and reasonable price, to amend and extend the contracts listed below; 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 Deputy Chief Administrative Officer, Health and Human Services Agency.
a. Substance Use Disorder Residential Treatment Program (553433 McAlister Institute for Treatment and Education) - Extend the contract term up to 12 months, and up to an additional six months, if needed.
b. Behavioral Health Collaborative Court (551670 Telecare Corporation) - Extend the contract term up to 12 months, and up to an additional six months, if needed.
c. San Diego’s Web Infrastructure for Treatment Services (553427 FEI.com, Inc.) - Extend the contract term up to 24 months, and up to an additional six months, if needed.
d. Breaking Down Barriers (559599 Jewish Family Service of San Diego) - Extend the contract term up to 18 months, and up to an additional six months, if needed.
e. Suicide Prevention, Stigma Reduction, and Substance Use Prevention Multi-Media Campaign (561649 Rescue Agency Public Benefit, LLC) - Extend the contract term up to 17 months, and up to an additional six months, if needed.
4. Authorize the acceptance of an estimated $800,000 in Mental Health Student Services Act grant funding from the Mental Health Services Oversight & Accountability Commission and authorize the Deputy Chief Administrative Officer, Health and Human Services Agency, or designee, to execute all required grant documents, upon receipt, including any annual extensions, amendments or revisions that do not materially impact or alter the services or funding level. Additionally, waive the Board Policy B-29 requirement for full cost recovery associated with the additional Mental Health Student Services Act grant for administrative overhead costs.
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 (SMI) or serious emotional disturbance. BHS is also the service delivery system for Medi-Cal eligible residents with substance use care needs. In 2022, nearly one in three San Diegans were eligible for Medi-Cal, with Hispanic and Latino residents having the highest percentage of Medi-Cal eligibility at 38%.
For these Medi-Cal eligible residents who experience SMI or have a substance use care need, BHS offers County-operated and BHS-contracted programs that address the social determinants of health by being accessible, capable of meeting the needs of diverse populations, and culturally responsive, with the intent to equitably distribute services to those most in need. In doing so, BHS strives to reduce behavioral health inequities, identifying needs and designing services in a manner most impactful and equitable, and will yield meaningful outcomes for those served. A comprehensive array of behavioral health services is vital for BHS to continue providing access to treatment and care for populations who are underserved by social and behavioral health resources.
SUSTAINABILITY IMPACT STATEMENT
Today’s actions support the County of San Diego Sustainability Goal #2 to provide just and equitable access to County services and Sustainability Goal #4 to protect the health and well-being of everyone in the region. These goals 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. Access to a comprehensive continuum of behavioral health services will improve the overall health of communities.
FISCAL IMPACT
Funds for these requests are included in the Fiscal Year (FY) 2024-26 Operational Plan in the Health and Human Services Agency. If approved, today’s recommendations will result in approximate costs and revenue of $10.5 million in FY 2024-25 and $88.8 million in FY 2025-26. 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 $0.5 million in FY 2024-25 and estimated costs and revenue of $76.2 million in FY 2025-26. The funding sources are Mental Health Services Act (MHSA), existing Realignment, and existing General Purpose Revenue under the Maximize American Rescue Plan Act Revenue Strategy. There will be no change in net General Fund cost and no additional staff years.
Recommendation #2: Authorize Single Source Procurements
If approved, this request will result in estimated costs and revenue of $1.7 million in FY 2024-25 and estimated costs and revenue of $3.4 million in FY 2025-26. The funding sources are MHSA, Drug Medi-Cal (DMC) and Short Doyle Medi-Cal. There will be no change in net General Fund cost and no additional staff years.
Recommendation #3: Authorize Amendments to Extend Existing Contracts
If approved, this request will result in estimated costs and revenue of $8.1 million in FY 2024-25 and estimated costs and revenue of $9.0 million in FY 2025-26. The funding sources are MHSA, existing Realignment, Substance Use Block Grant, DMC, California Department of State Hospitals, California Department of Social Services. There will be no change in net General Fund cost and no additional staff years.
Recommendation #4: Authorize Acceptance of Grant Funds from Mental Health Services Oversight and Accountability Commission
If approved, this request will result in estimated costs of $0.20 million and revenue of $0.18 million in FY 2024-25 which will be covered by existing appropriations, estimated costs of $0.20 million and revenue of $0.19 million in FY 2025-26, and estimated costs of $0.46 million and revenue of $0.43 million in FY 2026-27 for a total cost of $0.86 million and total revenue of $0.80 million from FY 2024-25 through FY 2026-27. The funding source is Mental Health Student Services Act. Funds for subsequent years will be incorporated into future operational plans. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. The B-29 costs are $0.02 million for FY 2024-25, $0.01 million for FY 2025-26 and $0.03 million for FY 2026-27, for a total of $0.06 million for the term of this grant. The funding source for these costs will be existing Realignment allocated for this program. The public benefit for providing these services far outweighs these costs. 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 October 3, 2024, the Behavioral Health Advisory Board voted to approve these recommendations.
BACKGROUND
The County of San Diego (County) Health and Human Services Agency (HHSA), Behavioral Health Services (BHS) provides a comprehensive array of 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 and contracts with local public and private agencies. If approved, today’s action would authorize competitive solicitations, single source procurements, amendments to extend existing contracts, and acceptance of Mental Health Student Services Act grant funds from the Mental Health Services Oversight and Accountability Commission. This item supports the continuation of critical work to advance the ongoing transformation of the behavioral health continuum of care throughout San Diego County. Most of the contracts included are expiring in Fiscal Year (FY) 2024-25. 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. 24-hour Mental Health Rehabilitation Centers
On December 12, 2006 (7), the San Diego County Board of Supervisors (Board) authorized the single source procurements of 24-hour Mental Health Rehabilitation Centers (MHRCs) for clients with serious mental illness (SMI). Subsequently, on February 14, 2017 (6) and November 16, 2021 (5), the Board authorized contract term extensions of the Alpine Special Treatment Center up to June 30, 2022, and June 30, 2027, respectively, and up to an additional six months, if needed.
MHRCs are long term care programs that provide 24-hour residential behavioral health services to adults, ages 18-64, who have a primary diagnosis of a serious mental illness. MHRCs are intended to help clients develop skills to become self-sufficient and capable of increasing their levels of independence and functioning. The goal is successful transition to community-based housing and care. Care may include psychiatry, clinical psychology, psychiatric nursing, social work, rehabilitation, drug administration, and appropriate food services. Services are provided countywide.
MHRCs operate with 100% program utilization of the available 299 beds and have an ongoing waitlist for additional admissions due to the high number of clients in the hospitals requiring these services as a step-down from acute psychiatric services. In FY 2023-24, these programs served a total of 432 unduplicated clients. Additionally, over 85% of the 136 clients with a planned discharge transitioned to a lower level of care, nearly reaching the 90% program outcome goal. Furthermore, only 7% of the 151 total discharges required a higher level of psychiatric care while placed in an MHRC, achieving the program outcome goal of less than 15% requiring a higher level of care.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of 24-hour MHRCs for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed.
b. Locum Tenens Services
On April 24, 2018 (3), the Board authorized the competitive procurement of locum tenens services which includes the staffing of locum tenens professionals, such as adult psychiatrists, medical doctors, internal medicine specialists, family practitioners, and advanced practice professionals to serve in County-operated mental health facilities. The goals of clinical services provided by locum tenens professionals include accurately diagnosing and treating conditions to alleviate severe symptoms, ensuring patient safety, reducing recidivism, increasing life and community living skills, and facilitating patients’ reintegration into the community. Locum tenens professionals also provide consultation to multidisciplinary staff and participate in treatment team meetings. Services are patient-centered, culturally relevant and based on best practice according to their specialization. Services are provided countywide at specific sites including San Diego County Psychiatric Hospital, Edgemoor, public health clinics and outpatient mental health settings.
The County has relied upon locum tenens services to ensure coverage in various service areas throughout County-operated mental health facilities due to staff turnover, difficulty in recruiting and retaining psychiatrists and physicians, unexpected absences of psychiatrists and physicians, and the need to cover weekend, evening, and holiday shifts. The County has undertaken several steps to fill psychiatrist vacancies, including modifying qualifications at time of application, advertising in medical publications, attending booths at career fairs, and authorizing the use of agencies specializing in psychiatrist recruitment for employment, however, these efforts have been unsuccessful. While the County continues to explore avenues to fill such positions, a contract for Locum Tenens Services is needed to ensure operations continue.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of Locum Tenens Services for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed.
c. Children and Youth Crisis Stabilization Unit
On April 27, 2010 (10), the Board authorized the single source procurement of the Children and Youth Crisis Stabilization Unit (CYCSU), currently known as the Emergency Screening Unit. Subsequently, on November 7, 2023 (31), the Board authorized a contract term extension of this program up to June 30, 2026, and up to an additional six months, if needed.
The CYCSU is a certified outpatient behavioral health crisis stabilization program offering outpatient diagnostic and treatment services for children and youth under the age of 18. CYCSU services are provided countywide and are available seven days per week, 24 hours per day, which includes psychiatric evaluations, mental health assessments, crisis intervention and stabilization, brief outpatient counseling, case management, and medication management. Services are delivered in a community-based setting, aimed at diverting children and youth from emergency departments and inpatient hospitalization and connecting them to ongoing care.
Crisis services are essential to behavioral health networks, supporting continuous care for managing mental health conditions, similar to other chronic health conditions. In FY 2023-24, the CYCSU received a total of 1,392 admissions and served a total of 998 unduplicated clients. Of these admissions, approximately 70% were diverted from inpatient hospitalization.
Today’s action requests the Board authorize a competitive solicitation for the re-procurement of the CYCSU for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed.
d. Medi-Cal Training and Technical Assistance for Community-Based Behavioral Health Providers
On February 27, 2024 (11), the Board allocated $10.0 million of the Evergreen component of the American Rescue Plan Act Framework to expand the behavioral health workforce in San Diego County through the development of training and technical assistance. The goal is to support efforts that engage and expand the pool of organizations equipped to provide Medi-Cal funded behavioral health care. Engaging and equipping small and minority-owned community-based organizations (CBOs) to deliver Medi-Cal funded, mild-to-moderate mental health and substance use care, will broaden the diversity and array of providers in the region. This program is also anticipated to improve behavioral health outcomes for Black, Indigenous, and People of Color (BIPOC) who disproportionately experience adverse behavioral health symptoms by more closely aligning the behavioral health workforce to the community it serves.
Several CBOs currently provide behavioral health care in San Diego County but are not certified as Medi-Cal providers, thus are ineligible to receive reimbursements for services provided to Medi-Cal beneficiaries. State Medi-Cal provider enrollment requirements and standards can be complex and often impose a significant administrative burden on smaller agencies, despite their expertise and ability to provide services. A training and technical assistance program would support CBOs by providing funding and guidance to complete the necessary technical processes and mechanisms required by the California Department of Health Care Services. In addition to enabling reimbursements, technical support services are anticipated to better position such organizations for public and private contracts to provide Medi-Cal funded behavioral health care to those with mild-to-moderate behavioral health needs. This shift in the provider landscape could also create opportunities for BIPOC to become interested and involved in the delivery of care, increasing representation of diverse communities in the local behavioral health care workforce.
Today’s action requests the Board authorize a competitive solicitation for the procurement of a new Medi-Cal Training and Technical Assistance for Community-Based Behavioral Health Providers for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed.
Recommendation #2: Authorize Single Source Procurements
a. Adult Substance Use Outpatient Program for Alcohol Use
On December 1, 2016, under Board Policy A-87, the Department of Purchasing and Contracting authorized the single source procurement of the Adult Substance Use Outpatient Program for Alcohol Use, formerly known as Serial Inebriate Program. On November 16, 2021 (5), the Board authorized a contract term extension up to June 30, 2024, and up to an additional six months, if needed.
The Adult Substance Use Outpatient Program for Alcohol Use operates in the Central region, providing outpatient substance use treatment, recovery, and ancillary services to adults over the age of 18 with a primary alcohol use condition, and may include co-occurring mental health and other substance use conditions. Services include screenings, assessments, substance use group and individual counseling, intensive case management, peer support, and recovery services at a trauma-informed care facility that utilizes evidence-based practices, specific for alcohol use disorders. In addition, the program collaborates with the San Diego Police Department for direct referrals as an alternative to incarceration and to reduce recidivism. This program also supports the County efforts to address homelessness by providing stable housing for clients while engaged in treatment.
In FY 2022-23, the San Diego Police Department arrested 1,990 individuals for public alcohol intoxication and connected them to treatment services. In FY 2023-24, the program received 229 referrals and served a total of 159 unduplicated clients. Of the 26 program participants who completed treatment, 100% were housed at discharge after experiencing homelessness upon admission. Additionally, 92% of these participants were employed or in a formal education program at the time of discharge.
This program qualifies for a single source contract based on the following section of 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. Mental Health Systems, Inc. (MHS) is the sole provider in San Diego County with an established alcohol use treatment program with unique knowledge of providing alcohol use treatment services to the target population of adults with a primary alcohol use condition who have recently had justice involvement and/or are experiencing homelessness. Furthermore, MHS provides 56 housing beds for clients engaged in treatment at this program. Providing clients with stable housing while engaged in treatment enables the clients to be successful in maintaining sobriety and reaching their treatment goals.
Today’s action requests the Board authorize a single source contract with MHS for the Adult Substance Use Outpatient Program for Alcohol Use for an Initial Term of six months, with four 1-year Options, and up to an additional six months, if needed.
b. School-Based Outpatient Behavioral Health Services
On January 24, 2017 (2), the Board authorized the single source procurement of School-Based Outpatient Behavioral Health Services. Subsequently on July 18, 2023 (14), the Board authorized the single source procurement of 13 School-Based Outpatient Behavioral Health Services contracts with existing contractors including San Ysidro Health for the Youth Enhancement Services program. The outpatient programs provide culturally competent behavioral health services at designated schools, home, community or office/clinic locations, as well as via telehealth. The regionalized 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 up to age 21, and their families.
Beginning in 2002, the Board began awarding and extending school-based contracts through a single source process. The County continues to work extensively with elementary, middle and high schools, and existing and potential providers to create an infrastructure that ensures that the entities selected to provide services on school campuses are the choice of the school districts. Over the years, this partnership has resulted in a system of care that emphasizes accessibility of behavioral health services on school campuses, with services tailored to the needs of the students, caregivers and schools.
During FY 2023-24, BHS had 28 school-based contracts, one of which was San Ysidro Health for the Youth Enhancement Services program serving the South region. However, the contract with San Ysidro Health has ended on June 30, 2024, as the organization has shifted focus to serving children and youth through their Federally Qualified Health Center. To maintain access to specialty mental health services at school campuses in the South region, it is recommended to establish a new contract with SBCS Corp., the School District choice, to continue the services previously provided by San Ysidro Health to 235 unduplicated clients annually in the South region. SBCS Corp. is already a current school-based services provider in the South region under a different contract.
SBCS Corp. has been selected by the San Ysidro School District to provide school-based mental health services, and has established agreement to provide these services, therefore this qualifies as a single source contract based on Board Policy A-87 Competitive Procurement, Section 1D-4: A service provider has an exclusive agreement with the supplier and no other entity may provide the services. 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 district that cannot be replicated.
Today’s action requests the Board authorize a single source contract with SBCS Corp. as the San Ysidro School District choice for school-based behavioral services in the South Region for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed. If approved, today’s action will ensure efficient continuation of school-based behavioral health services in the South Region.
Recommendation #3: Authorize Amendments to Extend Existing Contracts
a. McAlister Institute for Treatment and Education (Contract #553433)
On March 27, 2018 (2), the Board authorized the single source procurement of the Drug Medi-Cal certified 24-hour Substance Use Teen Residential Treatment Program. Subsequently, on November 15, 2022 (28), the Board authorized a contract term extension of this program up to December 31, 2024. The Substance Use Teen Residential Treatment Program provides residential substance use treatment, recovery, and ancillary services countywide to youth ages 12-17 with substance use issues, including co-occurring mental health needs. Services are trauma-informed, developmentally appropriate, built on evidence-based practices, and include case management and community linkage, individual and group counseling, and coordination with the County Child and Family Well-Being Department and Justice Partners.
In FY 2023-24, 93 unduplicated clients were served. Of these clients, 98.5% had no new arrests, 100% of clients were referred to outpatient services, 94.1% were employed or in school, and 97.1% of those experiencing homelessness at intake were housed at the time of discharge.
Today’s action requests the Board authorize an extension of the current contract with McAlister Institute for Treatment and Education up to 12 months, and up to an additional six months, if needed. If approved, this extension will allow time for fiscally viable rate development under Medi-Cal Transformation and exploration of options for maintaining this critical level of care and a potential redesign of the program’s scope.
b. Telecare Corporation (Contract #551670)
On September 23, 2014 (9), the Board authorized the procurement of the Behavioral Health Collaborative Court behavioral health treatment program. Subsequently, on July 18, 2023 (14), the Board authorized the contract term extension of this program up to June 30, 2024, and up to an additional six months, if needed.
The Behavioral Health Collaborative Court includes an 18-month behavioral health treatment program that provides clinical case management, mental health services, substance-induced psychiatric disorder rehabilitation treatment, and recovery services to adults ages 18 and older with SMI. The countywide program assists participants in managing SMI and co-occurring conditions to prevent future justice involvement and reduce recidivism by focusing on criminogenic risk and needs which will lessen the cost of repeatedly going through the criminal justice system for low-level, non-violent offenses. Participants of the program must be referred through the Collaborative Behavioral Health Court of San Diego County Superior Court.
This program has shown effectiveness in decreasing recidivism as participants transition from custody to community. In FY 2023-24, the program served a total of 169 unduplicated clients. Of those clients, 82.2% remained the same or showed improvement in their functional status and 80% remained the same or showed improvement in their clinical status. In FY 2023-24, 29 participants graduated from the behavioral health court program, with 100% of the participants successfully housed.
Today’s action requests the Board authorize an extension of the current contract with Telecare Corporation up to 12 months, and up to an additional six months, if needed. A Memorandum of Understanding (MOU) is currently being developed to clearly define the roles, responsibilities and processes in the collaborative court setting. This MOU will inform the Statement of Work that is being developed for the Behavioral Health Collaborative Court treatment program and it is critical for both to be aligned. There is anticipated funding from the Board of State and Community Corrections that will further inform the scope of the behavioral health court treatment program. The implementation period for that grant is through March 2025. If awarded, the Board will be informed, and Board authority will be sought prior to implementation.
c. FEI.com, Inc. (Contract #553427)
On August 2, 2005 (15), the Board authorized the procurement of San Diego’s Web Infrastructure for Treatment Services (SanWITS). Subsequently, on March 27, 2018 (2), the Board authorized a contract term extension up to June 30, 2025, to support the expanded substance use disorder (SUD) provider network capacity, its local oversight, and system-wide care coordination. SanWITS is the BHS clinical database that supports Medi-Cal billing for SUD programs. This database collects program and services, demographic and outcome information from adults and adolescents seeking substance use prevention and treatment.
BHS is transitioning to SmartCare as the clinical and billing database. However, SanWITS is still required to complete billing reconciliation activities after the transition date of September 1, 2024. Additionally, SanWITS will remain in use for providers to access former client information for care purposes on an ongoing basis. The extension of the current contract with FEI.com, Inc. is necessary to support retroactive billing reconciliation, clinical care continuity, data migration, and archival requirements for SUD contracted providers countywide.
Today’s action requests the Board authorize an extension of the current contract with FEI.com, Inc. up to 24 months, and up to an additional six months, if needed.
d. Jewish Family Service of San Diego (Contract #559599)
On February 1, 2019, the Department of Purchasing and Contracting authorized the procurement of the Breaking Down Barriers Program. Subsequently, on July 18, 2023 (14), the Board authorized a contract term extension of this program up to December 31, 2024. On November 7, 2023 (31), the Board authorized a competitive solicitation for these services. Services were redesigned in alignment with community input as part of this new competitive solicitation, however, release of the solicitation was paused after the passage of Proposition 1 in March 2024 to align with new requirements and funding availability under the Behavioral Health Services Act (BHSA).
Beginning July 1, 2026, prevention funding under the existing Mental Health Services Act (MHSA), which funds the Breaking Down Barriers program, will shift to the California Department of Public Health (CDPH) and therefore will no longer be available as a funding source for the program. Additionally, BHSA will require counties to conduct more rigorous outreach, education, and engagement as part of the mandated Community Program Planning (CPP) process, which the Breaking Down Barriers program would support. Mandated engagement under MHSA was previously conducted with 11 identified stakeholder groups, but under BHSA, this will expand to over 20 distinct stakeholder groups. BHS is requesting an extension of the Breaking Down Barriers contract to support continuity of services while alternate funding options are explored and while awaiting detail and secondary BHSA guidance from the State, which will inform the future design of the Breaking Down Barriers program.
Today’s action requests the Board authorize an extension of the current contract with Jewish Family Service of San Diego for up to 18 months, and up to an additional six months, if needed, due to the passage of Proposition 1 and new requirements associated with the implementation of the BHSA.
e. Rescue Agency Public Benefit, LLC (Contract #561649)
On September 23, 2014 (9), the Board authorized the procurement for a public education campaign to reduce suicide risk and stigma. Building on this effort, on November 13, 2018 (12), the Board authorized the competitive procurement for the It’s Up to Us campaign. The procurements were subsequently combined, expanding the scope of the public messaging campaign series to include stigma reduction, suicide prevention, and substance use prevention. Recently, on April 30, 2024 (25), the Board authorized a revenue agreement with the City of San Diego allowing the County to accept $1.0 million of City of San Diego’s Opioid Settlement Funds for overdose prevention and naloxone public messaging. These funds will leverage existing It’s Up to Us campaign materials focused on overdose prevention and naloxone promotion and creation of new materials in collaboration with the City of San Diego. The It’s Up to Us campaign includes a series of multi-media public messaging focused on key behavioral health topics, including stigma reduction and substance use prevention. Additional public messaging campaigns to raise awareness for youth mental health, youth suicide prevention, crisis response services, and opioid overdoses are under development for release later this FY 2024-25.
Beginning July 1, 2026, Prevention funding under the existing MHSA, the primary funding source for the It’s Up to Us campaign, will shift to the CDPH and will no longer be available to fund this program. Additionally, BHSA will require counties to enhance outreach, education, and engagement as part of the mandated CPP process, which includes public messaging to various audiences about multiple behavioral health topics, as well as ad-hoc and responsive campaigns related to services, and informing stakeholders of changes catalyzed by recent policy changes. BHS is requesting an extension of the It’s Up to Us contract to support continuity of services while alternate funding options are explored and awaiting details and secondary BHSA guidance from the State, which will inform the future design of the It’s Up to Us program.
Today’s action requests the Board authorize an extension of the current contract with Rescue Agency Public Benefit, LLC for up to 17 months, and up to an additional six months, if needed, due to the passage of Proposition 1 and new requirements associated with the implementation of the BHSA.
Recommendation #4: Authorize Acceptance of an Estimated $800,000 from the Mental Health Services Oversight & Accountability Commission (MHSOAC)
On February 25, 2020 (13), the Board approved the County BHS to apply for and accept Mental Health Student Services Act (MHSSA) grant funds of approximately $6.0 million through the MHSOAC. Additionally, in accordance with Board Policy B-66, a contract was executed on January 1, 2022, with the San Diego County Office of Education (SDCOE) to implement the Creating Opportunities in Preventing and Eliminating Suicide (COPES) program. BHS collaborated with SDCOE in the implementation of the MHSSA grant which focuses on suicide prevention services such as providing training and suicide awareness education for key staff and educating parents and students in suicide prevention efforts. On April 18, 2022, the MHSOAC released Request for Application (RFA-003) for MHSSA. BHS applied for and was awarded an additional $1.1 million in MHSSA grant funding to augment the COPES program. On May 16, 2024, the MHSOAC released Request for Applications (RFA-004) for additional MHSSA grant funds. RFA-004 is available only to current MHSSA grantees. The goal of the RFA-004 is to provide services through grants in the following categories: (1) Marginalized and Vulnerable Youth, (2) Universal Screening, (3) Sustainability, and (4) “Other Priorities” to allow applicants to identify and address their unique needs. Subsequently, on August 26, 2024, the MHSOAC issued the Notice of Intent to Award $800,000 to the County BHS for FY 2024-25 through FY 2026-27. The additional grant will build on the COPES services to develop a local planning team to create a roadmap for mental health universal screening and will be managed through SDCOE.
Today’s actions request the Board authorize the acceptance of an estimated $800,000 of additional MHSSA grant funding and authorize the Agency Director, Health and Human Services Agency, or designee, to execute all required grant documents, upon receipt, including any annual extensions, amendments or revisions that do not materially impact or alter the services or funding level. Additionally, today’s action requests the Board waive the Board Policy B-29 requirement for full cost recovery associated with the additional MHSSA grant for administrative overhead costs. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. The B-29 costs are $13,750 for FY 2024-25, $13,940 for FY 2025-26 and $32,342 for FY 2026-27 for a total of $60,032 for the term of this grant. The funding source for these costs will be existing Realignment allocated for this program. The public benefit of providing these services far outweighs the B-29 unrecoverable costs and allows for the maximization of grant funds used to implement the project. Without the revenues, the ability to improve children’s and youth’s access to behavioral health services at school sites will be impacted.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed actions support the County of San Diego 2024-2029 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,
ebony n. shelton
Chief Administrative Officer
ATTACHMENT(S)
N/A