City Council
December 20, 2022
AGENDA REPORT
TO: Edward D. Reiskin FROM: Estelle Clemons
City Administrator Interim Director, Human
Services
SUBJECT: City of Oakland Mental Health
Resilience Project SAMHSA Grant
DATE: November 21, 2022
City Administrator Approval Date:
RECOMMENDATION
Staff Recommends That The City Council Adopt A Resolution:
1. Accepting And Appropriating A Grant From The Department Of Health And Human Services (DHHS) Substance Abuse And Mental Health Services Administration (SAMHSA) In The Amount Of One Million Two Hundred Thirty Thousand Dollars ($1,230,000) For The City Of Oakland: Mental Health Resilience Project From September 30, 2022 Through September 29, 2023; and
2. Approving 4.00 Full Time Equivalent Case Manager II Positions, 1.0 Full Time Equivalent Administrative Analyst I Position, 1.0 Full Time Equivalent Administrative Assistant II Position And 0.50 Full Time Equivalent Management Intern I Position In The Human Services Department From September 30, 2022 To September 29, 2023 For Required Program Implementation.
EXECUTIVE SUMMARY
The City of Oakland’s Human Services Department (HSD) was awarded a grant from the Department of Health and Human Services (DHHS) Substance Abuse and Mental Health Services Administration (SAMHSA) through the FY2022 Congressional Directive Spending Projects Notice of Funding Announcement FG-22-099. The funds will address the mental health impact of the COVID-19 pandemic for one year for a total award of $1,230,000 beginning September 30, 2022 through September 29, 2023. The purpose of this project is to develop a comprehensive mental health-focused, trauma-informed support system for Oakland families and seniors most impacted by COVID-19 pandemic.
The pandemic laid bare the effects of historic and structural racism that have left Black Indigenous People of Color (BIPOC) in East and West Oakland, vulnerable with limited access to quality mental health support and medical care, resulting in underdeveloped social- emotional growth (for children 0-5 years), and social isolation (for seniors.) Dec 6, 2022
Edward D. Reiskin, City Administrator
Subject: City of Oakland Mental Health Resilience Project SAMHSA Grant Date: November 21, 2022 Page 2
City Council
December 20, 2022
HSD will work with our highest COVID-impacted communities where the spread occurred quickly (particularly in East and West Oakland), to expand the need for mental health and parenting support systems for children and their families who participate in the City of Oakland Head Start Program, and for seniors experiencing the impact of seclusion and its resulting health effects, that attend East & West Oakland Senior Centers. The goal is to build on the strengths of the community, provide needed mental health supports, while assessing the traumatic impact that COVID has contributed to within the community.
BACKGROUND / LEGISLATIVE HISTORY
The Congressional Directive Spending Projects in SAMHSA’s FY 2022 Appropriation1 provides appropriations to federal agencies for the remainder of FY2022, including supplemental appropriations for activities to support various programs that address a wide range of policy areas.
SAMHSA's mission is to reduce the impact of substance use and mental illness on America's communities. SAMHSA works in partnership with states, communities, and private organizations to advance mental and substance use disorder prevention, treatment, and recovery services to improve individual, community, and public health.
The COVID-19 pandemic uncovered the historic and structural racism that have left Black Indigenous People of Color (BIPOC) in East and West Oakland, vulnerable with limited access to quality mental health support and medical care, resulting in underdeveloped social- emotional growth (for children 0-5 years), and social isolation (for seniors.)
As of October 12, 2022, Oakland has 99,135 reported COVID-19 cases2 with a disproportionate percentage of cases, hospitalizations, and deaths among Black and Latinx residents. While the long-term behavioral health effects of COVID-19 continue to be monitored, in June 2020, the CDC reported that Mental health conditions are disproportionately affecting specific populations - Latinx (Hispanic), Black, and essential workers 3, representing most type of
employment of the households in East and West Oakland.
ANALYSIS AND POLICY ALTERNATIVES
The Oakland Community Stressors Index (2019) indicates that many intersecting sources of stress and trauma are concentrated in East and West Oakland, home to many of Oakland’s Black and Latinx population. The Covid-19 pandemic added a layer of stress from mandated quarantines and self‐isolation most likely caused a negative impact on mental health.
Separation from loved ones, loss of freedom, boredom, and uncertainty can cause a deterioration in an individual's mental health status.
1 https://www.samhsa.gov/sites/default/files/samhsa-fy-2022-cj.pdf 2 https://covid-19.acgov.org/data.page
3 https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm
Edward D. Reiskin, City Administrator
Subject: City of Oakland Mental Health Resilience Project SAMHSA Grant Date: November 21, 2022 Page 3
City Council
December 20, 2022
Oakland seniors and aging adults over the age of 65 represent 13.4% (or 59,046) of the total City’s population. Those residing in East and West Oakland have experienced the highest impact during COVID in a variety of ways. At senior centers in East and West Oakland, about 1,000 seniors attend a variety of social activities at our seniors centers throughout the year, and participate in social activities such as yoga, dance classes, cooking, and computer literacy, and receive daily meals and groceries.
Aging and Adult Services is well suited to expand their case management model at senior centers to help assess the toll that COVID has brought onto the seniors within the community.
HSD will extend a pre-existing case management system utilizing the State of California’s Targeted Case Management (TCM) program, and Medi-CAL billing process. HSD has developed an in-depth knowledge of available social services and how to access these resources. The department has extensive experience with adults and seniors from low socio- economic populations which has bred familiarity and sensitivity to the most common health and social needs of our residents.
Children and families in the proposed service area are at high risk for experiencing toxic stress and high levels of trauma. Families residing in East and West Oakland experience trauma on a higher level due to the ongoing violence, crime activity and limited economic investment in these communities.
Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur in childhood.
ACEs increase the risk that a child will have negative, long lasting health issues during his or her lifetime. These long-term changes are known as the toxic stress response. The Department for Community Health and Engagement at the UCSF Benioff Children’s Hospital Oakland has studied the health and mental health implications on children of color. 4 Their research has found
that more than 20% of mostly Black and Latinx children in Oakland up to their 12th birthday have experienced discrimination. More than half have endured four forms of ACEs including food, and housing insecurity, community violence, and discrimination, which have been found to contribute to ACEs and leads to chronic health conditions that disproportionately affect communities of color.
The neighborhoods where these services will be provided have been impacted by years of public disinvestment and racially discriminatory government policies. This includes redlining, zoning laws that allowed pollution producing industry to locate there, and the building of highways that cut some of these neighborhoods off from the rest of the city. The result is unemployment rates twice that of the rest of the city, food deserts, low educational attainment, and families living in deep poverty. The long-term impact of living in these neighborhoods is lower life expectancy, due to high levels of gun violence, toxic stress, and chronic disease.
Throughout the grant term, funds will support HSD staff to implement a series of deliverables as detailed in the Proposed Implementation Approach Charts. As some deliverables will require specialized and supplemental training for staff, the first couple of months will be dedicated to attending training(s) and acquiring the knowledge around processes and approaches to ensure case management tasks will be completed accordingly.
4 https://www.ucsf.edu/news/2018/07/411161/disrupting-toxic-stress-children-prevent-long-term-health-impacts Edward D. Reiskin, City Administrator
Subject: City of Oakland Mental Health Resilience Project SAMHSA Grant Date: November 21, 2022 Page 4
City Council
December 20, 2022
Proposed Implementation Chart– Seniors / Aging Adults
Goals Objectives
1: Assess current mental health and well-
being for Seniors who were impacted by
COVID-19
1. By December 2022, complete Initial
Assessments using mental health
questionnaire, for 200 Seniors
2. By July – Sept. 2023, complete Interim
Assessment 9-12 months following initial
assessment for at least 50% of 200 cohort to
evaluate improvements on mental health
and quality of life
2: Develop service plans and increase case
management support services to address
unmet needs
1. By January-March 2023, using Initial
Assessments, create individual service plans
to address unmet need for all Seniors (who
completed an assessment)
2. By September 2023, provide information
and referral for at least one identified need
reflected on service plan
3. Follow-up and monitor service plans at
least once a month for each client (Senior).
3. Improve existing Case Management
model that will enhance program operations
to better serve clients in a sustainable way
1. By December 2022, train and re-train
staff on Medi-Cal billing process
2. By September 2023, enroll and serve at
least 50 unduplicated seniors though Medi-
Cal billing, on an ongoing basis
3. Implement standards based on State of
California - Targeted Case Management
(TCM) program
Proposed Implementation Chart – Children & Families
Goal Objective
1. Increase the capacity of Head Start staff
to identify and address potential social
and emotional concerns that contribute
to recognizing children in the 0-to-5-
year age group who are at risk for social
or emotional difficulties, identify
behaviors of concern to caregivers and
identify need for further assessment.
1. By December 2022, 80% of staff and
50% of parents will receive training
clinics on the purpose and completion of
the ASQ-SE screening tool.
2. By September 2023, 100% of children
enrolled in the Head Start program will
have a complete Ages & Stages
Questionnaire: Social-Emotional
screening.
3. By September 2023, 100% of children
identified as requiring rescreening will
have their screening complete.
4. By September 2023, 100% of children
with identified concerns will have an
individualized plan that responds to the
Edward D. Reiskin, City Administrator
Subject: City of Oakland Mental Health Resilience Project SAMHSA Grant Date: November 21, 2022 Page 5
City Council
December 20, 2022
Goal Objective
concerns and will be assigned a case
manager.
2. Increase the capacity of the Head Start
program staff to recognize and respond
to traumatic stress in children 0-to-5-
year old’s and their primary caregivers.
1. By January 2023, 80% of all staff will be
trained in ACES.
2. By September 2023, at least 2 staff will
be trained in conducting ACES
screenings for adults and children in the
Oakland Head Start program.
3. By June 2023, the Oakland Head Start
program will have a Trauma-Informed
Strategic Plan that the program will
implement in order to build and sustain a
system that recognizes, responds and
prevents trauma in the program.
Trainings will be provided to both staff and parents to help implement program objectives.
Professional service agreements will be entered into with experienced consultants and organizations with specialized, verified and demonstrated expertise within the areas of focus including ASQ-SE and ACES to address social emotional well-being for children and families.
County-Based Medi-Cal Administrative Activities (CAMAA), Targeted Case Management (TCM) and Complex Case Management (CCM) trainings will supplement existing case managements skills to help assess and address mental health and well-being for seniors who experienced social isolation and depression, in addition to deferred medical and health concerns.
County-Based Medi-Cal Administrative Activities (CMAA) program. CMAA became a Medi-Cal program on January 1, 1995, pursuant to Welfare and Institutions (W&I) Code §14132.47. Local Governmental Agencies (LGAs) and participating in the CMAA program are eligible to receive federal reimbursement for the cost of performing administrative activities that directly support efforts to identify and enroll potential eligible individuals into Medi-Cal. 5 Through the CMAA program, DHCS and individual county agencies promote access to health care for clients in the county public health system, minimize health care costs and long-term health care needs for at risk populations, and coordinate client health care needs with other health care providers. CMAA activities include, but are not limited to, conducting Medi-Cal outreach, facilitating Medi-Cal eligibility determinations, Medi-Cal program planning, and Medi- Cal contract administration.
6 CCM includes comprehensive assessments, promotion of the patient-centered medical home by facilitating a safe connection between patients, their caregivers and their PCP’s; care coordination, promotion of health self-management efforts, referrals to community resources,
5 https://www.dhcs.ca.gov/ProvGovPart/Pages/CMAA.aspx
6 https://www.dhcs.ca.gov/ProvGovPart/Pages/CMAA.aspx
Edward D. Reiskin, City Administrator
Subject: City of Oakland Mental Health Resilience Project SAMHSA Grant Date: November 21, 2022 Page 6
City Council
December 20, 2022
mutually agreed upon, individualized care plans that include targeted interventions, and patient engagement through phone and in-person encounters.7
TCM reimburses participating counties for the federal share of costs (typically 50%) for case management services provided to Medi-Cal beneficiaries in specific target populations.
Participating Local Governmental Agencies (LGAs) use their certified public expenditures (CPEs) to draw down federal funds.8
Accepting this grant for the City of Oakland Mental Health Resilience Project will ensure that the lingering mental health impact of the Covid-19 pandemic affecting children, families and Seniors from East and West Oakland, will be addressed and prioritized as the unknown effects of the pandemic is winding down. Electing not to accept this funding would result in a missed opportunity to address the historical and systematic impact these communities have endured with mental health and overall well-being.
In accordance with the City’s adopted Budget, the City’s activities are structured to support these priorities, and the Budget provides the framework through which these goals and objectives are achieved. The City of Oakland: Mental Health Resilience Project directly supports Housing, Economic, and Cultural Security, in addition to a Responsive, Trustworthy Government by recognizing the systematic and historical inequities that amplified the mental health and medical impact the COVID-19 pandemic has had on Oaklanders.
FISCAL IMPACT
Approval of this resolution will authorize the City Administrator to accept and appropriate a SAMHSA grant for a total of $1,230,000, for the grant term of September 30, 2022, to September 29, 2023. The City of Oakland Mental Health Resilience Project grant will be appropriated into FY 2022-2023, FY 2023-2024, budgets in the Department of Health and Human Services Fund (2128), Department of Human Services: Administration Organization (78111), SAMHSA City of Oakland: Mental Health Resilience Project (1005678) and Fostering Safe and Healthy Communities Program (SC22).
With City Council's approval of accepting this grant money, a total of $1,019,956 will be dedicated to hiring staff to implement the grant programming. An estimated amount of $684,668 of grant funding will be allocated towards hiring 4.00 Full Time Equivalent (FTE) Case Manager II positions, an estimated annual amount of $161,521 will be allocated towards hiring 1.00 FTE Administrative Analyst I position, an estimated annual amount of $138,160 will be allocated towards hiring 1.00 FTE Administrative Assistant II position, and an estimated annual amount of $35,607 will be allocated towards hiring a 0.50 Full Time Equivalent (FTE) Management Intern I.
As an assumed part of their managerial supervision duties, department managers and directors will provide daily oversight of all grant activities and will ensure all grant deliverables and reporting deadlines are on track and will not incur any additional salary allocations to this project.
7 https://thealliance.health/for-providers/manage-care/clinical-resources/care-management/complex-case-management-and-care- coordination/
8 https://www.dhcs.ca.gov/provgovpart/Pages/TCM.aspx
Edward D. Reiskin, City Administrator
Subject: City of Oakland Mental Health Resilience Project SAMHSA Grant Date: November 21, 2022 Page 7
City Council
December 20, 2022
An estimated amount of $129,930 of grant funding will be allocated towards contracting with professional consultants. Table 1 below provides a breakdown of the professional service agreements:
Table 1
Professional Service Agreements Amount
Through the Looking Glass $50,000
NLeader Group, LLC $35,000
University of California San Francisco Center For Excellence In Primary Care
$19,930
Mental Health Consultant Support for Seniors – TBD $25,000 City of Oakland Mental Health Resilience Project Total: $129,930
The remainder of the grant money will be going to minor office supplies, equipment, travel and printing.
PUBLIC OUTREACH / INTEREST
This item does not require any additional public outreach other than the required posting on the City’s website.
COORDINATION
This report and legislation have been reviewed by the Office of the City Attorney, the Budget Bureau and the Workplace and Employment Standards.
SUSTAINABLE OPPORTUNITIES
Economic: Addressing existing mental health and medical challenges can help improve education outcomes, employment opportunities, and economic stability for Oakland's communities most affected by trauma, racism, violence, and civil unrest.
Environmental: There are currently no direct environmental benefits or impacts from the recommended policy.
Race & Equity: The overarching goal of this grant is to address the historical and systematic inequities that continue to affect the community. Based on the equity analysis completed by Head Start and Senior Services divisions, this program was designed to meet the needs that were amplified in those equity analysis. This project will be targeted in neighborhoods located in East and West Oakland, where the impact of COVID-19 disproportionally effected the communities that have limited access to quality mental health support and medical care.
Edward D. Reiskin, City Administrator
Subject: City of Oakland Mental Health Resilience Project SAMHSA Grant Date: November 21, 2022 Page 8
City Council
December 20, 2022
ACTION REQUESTED OF THE CITY COUNCIL
Staff Recommends That The City Council Adopt A Resolution:
1. Accepting And Appropriating A Grant From The Department Of Health And Human Services (DHHS) Substance Abuse And Mental Health Services Administration (SAMHSA) In The Amount Of One Million Two Hundred Thirty Thousand Dollars ($1,230,000) For The City Of Oakland: Mental Health Resilience Project From September 30, 2022 Through September 29, 2023; and
2. Approving 4.00 Full Time Equivalent Case Manager II Positions, 1.0 Full Time Equivalent Administrative Analyst I Position, 1.0 Full Time Equivalent Administrative Assistant II Position And 0.50 Full Time Equivalent Management Intern I Position In The Human Services Department From September 30, 2022 To September 29, 2023 For Required Program Implementation.
For questions regarding this report, please contact Martina Bouey, Assistant to the Director, at 510-238-7242.
Respectfully submitted,
ESTELLE CLEMONS
Interim Director, Human Services Department
Reviewed by:
Martina Bouey, Assistant to the Director
Prepared by:
Cindy King, Health & Human Services Program
Planner
Human Services Department