Fremont City Council Meeting: 09/03/24 07:00 PM
3300 Capitol Avenue Div/Dept: Human Services Department Fremont, CA 94538 Category: Agreements and Contracts
SCHEDULED
Sponsors:
COUNCIL STAFF REPORT (ID # 5226) DOC ID: 5226
Updated: 8/27/2024 11:28 AM by Dina Lewis Page 1
MENTAL HEALTH SERVICES AGREEMENTS - Authorization to Execute Agreement with Alameda County Behavioral Health and La Familia to provide Mental Health Services; and Making Findings of CEQA Exemption Contact Persons:
Name: Annie Bailey Christina Briggs
Title: Youth and Family Services
Administrator
Assistant City Manager
Div/Dept: Human Services Department City Manager's Office Phone: 510-574-2111 510-284-4022
E-Mail: [email protected] [email protected]
Executive Summary: Staff recommends that the City Council authorize the City Manager to enter into two agreements not to exceed $3,063,014, including: (1) an agreement with Alameda County Behavioral Health (ACBH), in the amount of $2,795,126 for the Human Services Department’s Youth and Family Services (YFS) Division, Aging and Family Services (AFS) Division, and Family Resource Center (FRC) Division to provide mental health services and increase its capacity to provide services; and (2) an agreement with La Familia, in the amount of $267,888, for FRC Division to provide mental health counseling services, as part of a multi-disciplinary Working Wellness Program, to adults receiving CalWORKs benefits, who are enrolled in the Welfare to Work program and facing mental health challenges transitioning to work.
BACKGROUND:
ACBH Mental Health Services Contract
The Human Services department has provided Medi-Cal funded services to South County residents for many years, including mental health services, substance use disorder services and Targeted Case Management services.
Medi-Cal is California’s Medicaid health care program. This program pays for services for children and adults with limited income and resources. Currently, the Medi-Cal program is undergoing a transformative system change, moving away from the state funding individual services, to the California Advancing and Innovating Medi-Cal (CalAIM) program, with the goal of:
a. improving population health using a whole person care model and social determinants of health,
b. Reducing complexity and variation, and increasing flexibility of services across Medi- Cal, and
c. Improving quality outcomes, reducing health disparities, and modernizing systems through value-based initiatives and payment reform.
Beginning in FY 2024/25, as part of the CalAIM transformation process, ACBH will change the payment model for behavioral health contracts. For many years, the County provided reimbursement for Early Periodic Screening Diagnosis and Treatment (EPSDT) services Council Staff Report (ID # 5226) Meeting of September 3, 2024 Updated: 8/27/2024 11:28 AM by Dina Lewis Page 2
based on the City’s actual costs up to a maximum allowed rate, which required the development of interim reimbursement rates and a final cost settlement each year. Under the new fee for service model, the City will no longer have to go through a cost settlement process and will instead be paid a negotiated rate regardless of its costs.
The YFS Division has received Medi-Cal reimbursement from ACBH for eligible mental health services since FY 1999/2000. YFS provides services to children with “full-scope Medi- Cal” (i.e., complete Medi-Cal coverage) that are funded through EPSDT, which is the joint county, state, and federal Medicaid reimbursement mechanism for services provided to children.
The AFS Division has provided mental health services to isolated seniors in their homes since 2008. This portion of the agreement is partially funded through Mental Health Services Act (MHSA), which was designed to expand and transform California’s county mental health services system. MHSA provides supplemental funding for mental health services through an additional one percent tax on individual taxable incomes of $1 million or more.
Shortly after the passage of MHSA, a county-wide planning process identified a need for geriatric mental health services, specifically targeted at seniors isolated in their homes and unable to access services due to transportation and physical/mental health barriers. As a result of this identified need, the City developed the Mobile Mental Health Team to provide geriatric mental health services in southern Alameda County and thereby improve the mental health of seniors 60 years of age and older, who are 1) isolated and therefore unable to access clinic services, and 2) unable to manage independence due to physical/mental disabilities. These seniors are often at risk of institutionalization, nursing home care, hospitalization, repeated 911 calls, and emergency room visits. AFS has subsequently added a Recovery & Resiliency (R&R) step-down program, a peer support program for LGBT+ older adults, and an Asian American and Pacific Islander (AAPI) community support program.
The FRC, AFS, and YFS Divisions also provide Adult Outpatient Therapy services to adults with moderate to severe mental health issues. Services are provided by licensed staff, Associate Social Workers, and graduate clinical interns.
The FRC Division has collaborated with Alameda County since 2001 to form a multi- disciplinary and multi-agency Family Service Team (FST) for clients with multiple issues, who are receiving public assistance through CalWORKs. The City has provided mental health and wrap-around services, helping participants move from welfare to work.
Alameda County re-bid these contracts for FY 2019/20 and required providers to serve a much larger geographic area of the County which included the Tri-Cities, the Tri-Valley area, Hayward, and San Leandro. Together, the City and La Familia submitted a successful application under a new program name, the Working Wellness Program, with La Familia as the lead agency and the City as a subcontractor, to provide these services to an expanded south county group of CalWORKs participants.
DISCUSSION/ANALYSIS:
The YFS Division, in FY 2024/2025, will provide approximately 7,669 service hours in the following categories:
Council Staff Report (ID # 5226) Meeting of September 3, 2024 Updated: 8/27/2024 11:28 AM by Dina Lewis Page 3
• Healthy Choices School-Site Counseling Services at Fremont school sites; • The Infant Toddler Program, which serves families with children who are five years old and younger. This program also includes the Early Connections project, which includes a full-time Family Partner that promotes family-driven mental health care for children;
• The Youth Service Center, which serves youth with mental health needs and their families;
• The Truancy Intervention and Probation Youth Program, which serves pre-delinquent and delinquent youth and their families; and
• Outpatient Adult Mental Health brief therapy services (the AFS and FRC divisions will provide additional support in providing these services).
In FY 2023/24, additional funding was added to the youth EPSDT programs to cover Intensive Care Coordination (ICC) for mental health clients. This is a form of Targeted Case Management (TCM) for youth.
The AFS Division will provide mental health services to a minimum of 200 clients a year in order to improve their ability to live safely in the community. The programs will provide 2,081 hours of outpatient services, which will include 500 hours of medication support, and an additional 450 hours of outreach and engagement. The team is multi-disciplinary, consisting of a part-time psychiatrist, part–time physicians’ assistant, licensed counselors, Human Services Specialist, and clinical supervisor. Outreach and services provision will happen in community settings, such as the Age Well Centers and Senior Housing. The team also visits isolated seniors in their own homes to diagnose their mental status and assess their need for mental health services. The treatment team works with the seniors, and where possible their family, to develop a treatment plan that may include prescribing and monitoring psychotropic medications, providing counseling, and referring seniors to other resources as needed. The Mobile Mental Health team works closely with the City’s senior case management program and Adult Protective Services, and coordinates home delivered meals and inpatient hospitalization, if needed.
In addition, AFS will provide a Mental Health Peer Coaching program to LGBTQ+ seniors.
The peer model was originally developed to reduce loneliness and increase self-efficacy among older adults (at least 60+) with severe to moderate mental illness. The model had positive outcomes that improved both coaches and the peer’s ability to have emotional, mental, and physical stability within a supportive environment. The peer support program was expanded to target LGBTQ+ population in FY 2016/17. The program includes process of engaging, empathetic listening, encouraging, and educating LGBTQ+ older adults around enhancing wellness and preventing isolation and reducing the stigma often experienced by LGBT+ older adults.
AFS added support services targeting older Asian American and Pacific Islander (AAPI) individuals in FY 2023/24. The older AAPI population has been underserved in mental health interventions. This program conducts community-based classes around wellness at locations where older adults naturally congregate, such as senior housing facilities and faith -based agencies. During FY 24/25, the first year of the program, over 200 AAPI older adults participated in the new program, the majority of the participants interacting with a trained mental health professional for the first time.
Council Staff Report (ID # 5226) Meeting of September 3, 2024 Updated: 8/27/2024 11:28 AM by Dina Lewis Page 4
The FRC Division, in FY 2024/2025, will continue to assist clients who are on CalWORKs in removing barriers to employment. The FRC Working Wellness program provides a coordinated and integrated system of support for clients and their families, which may include health, substance abuse and mental health services, as well as educational and job search assistance, aimed at helping them to exit the CalWORKs system. The model invites the Cal WORKs participant to be an active member of their treatment team. This program utilizes the Individual Placement and Support (IPS) model of Employment Services, provided by IPS staff from La Familia. In FY 2024/2025, the FRC will provide approximately 766 hours of service to 26 unduplicated clients.
The YFS, FRC and AFS divisions will provide 976 hours of service to 35 unduplicated clients in the Adult Outpatient Therapy program, referred by ACCESS.
FISCAL IMPACT: Funding under these agreements offsets the costs of full-time mental health professionals, clinical supervision, clerical support costs and City overhead expenses.
There is no impact to the General Fund. While the reimbursement rates for the fee-for- service portions of the agreements may vary between the contracts, the total maximum amount for which the City can be reimbursed remains at $3,063,014. As part of the FY 2024/25 Adopted Operating Budget, the City Council appropriated sufficient funds in Fund 104, 170 and 172 to meet contract requirements.
ENVIRONMENTAL REVIEW: This action is exempt from and is not subject to review under the California Environmental Quality Act (CEQA) pursuant to, without limitation, CEQA Guidelines section 15061(b)(3) and/or 15378(b)(2) and/or (5) as the activities contemplated are organizational activities of government that will not result in direct or indirect physical changes in the environment, each of the foregoing providing a separate and independent basis for CEQA exemption.
ATTACHMENTS: None.
RECOMMENDATIONS: Authorize the City Manager or her designee to execute two FY 2024/25 agreements totaling $3,063,014 including:
a. an agreement with Alameda County Behavioral Health (ACBH), in the amount of $2,795,126; and
b. an agreement with La Familia, in the amount of $267,888