HomeMy WebLinkAbout32836Agreement No. 13-316-2
AMENDMENT II TO AGREEMENT 1
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THIS AMENDMENT, hereinafter referred to as Amendment II, is made and entered into this
12th day of _____ Ju ..... n ___ e ____ , 2018, by and between COUNTY OF FRESNO, a Political
4 Subdivision of the State of California, hereinafter referred to as "COUNTY", and UPLIFT FAMILY
5 SERVICES, INC., a California non-profit Corporation, whose business address is 251 Llewellyn Ave,
6 Campbell, CA 95008, hereinafter referred to as "CONTRACTOR" (collectively the·"parties").
7 WHEREAS, the parties entered into that certain Agreement, identified as COUNTY Agreement
8 No. 13-316, effective July 1, 2013, and COUNTY Amendment No. 13-316-1, effective July 11, 2017,
9 herein collectively referred to as COUNTY Agreement 13-316, whereby, CONTRACTOR agreed to
10 provide a Mental Health Services Act (MHSA) funded Children/Youth Assertive Community Treatment
11 Program and provide integrated mental health and community support services; and
12 WHEREAS, the parties desire to amend the Agreement regarding changes as stated below and
13 restate the Agreement in its entirety.
14 NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which is
15 hereby acknowledged, COUNTY and CONTRACTOR agree as follows:
16 1. That the existing COUNTYAgreement No. 13-316, Section two (2) "TERM", shall be
17 revised by adding the following at Page Three (3), Line Three (3) after the word "2018".
18 ''This Agreement shall be extended for an additional six (6) month period beginning July
19 1, 2018 through December 31, 2018."
20 2. That the existing COUNTY Agreement No. 13-316, beginning on Page Four (4), Line
21 Seven (7) with the word "The" and ending on Page Four (4), Line Twenty-Six (26) with the word
22 "Dollars" be deleted and the following inserted in its place:
23 "For FY 2013-14, 2014-15, 2015-16, and 2016-17, the maximum compensation amount
24 under this Agreement for each twelve (12) month period identified shall not exceed One Million, Six
25 Hundred Seven Thousand, Four Hundred Eighteen and No/100 Dollars ($1,607,418.00). For FY 2017-
26 18, the maximum compensation amount under this Agreement for said twelve (12) month period shall
27 not exceed Two Million, Four Hundred Twenty-Nine, Eight Hundred Two and No/100 Dollars
28 ($2,429,802.00). For the six (6) month term extension of July 1, 2018 through December 31, 2018, the
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maximum compensation shall not exceed One Million, Two Hundred Fourteen Thousand, Nine
Hundred One and No/100 Dollars ($1,214,901.00) as identified in Revised Exhibit B-1, attached hereto
and incorporated herein.
The total maximum compensation under this Agreement for the entire term shall not
exceed Ten Million, Seventy-Four Thousand, Three Hundred Seventy Five and No/100 Dollars
($10,074,375.00).”
3. That, effective July 1, 2018, all references in existing COUNTY Agreement No. 13-316 to
“Exhibit A,” shall be changed to read “Revised Exhibit A-1,” attached hereto and incorporated herein by
reference.
4. That, effective July 1, 2018, all references in existing COUNTY Agreement No. 13-316 to
“Exhibit B and/or Revised Exhibit B,” shall be changed to read “Revised Exhibit B-1”.
5. COUNTY and CONTRACTOR agree that this Amendment II is sufficient to amend the
Agreement; and that upon execution of this Amendment II, the Agreement, Amendment I and
Amendment II together shall be considered the Agreement.
The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
covenants, conditions and promises contained in the Agreement and not amended herein shall remain in
full force and effect. This Amendment II shall become effective upon execution by all parties.
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1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment II to Agreement
2 No. 13-316 as of the day and year first hereinabove written .
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4 CONTRACTOR
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CES, INC.
7 Authorized gnature)
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rint Name e~t>
itle (Chairman of Board, o
EO)
orized Signature)
atA.FA...--loo
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itle (Secretary of Corporation, or Chief
inancial Officer/Treasurer, or any
ssistant Secretary or Treasurer)
19 MAILING ADDRESS:
251 Llewellyn Avenue
20 Campbell , CA 95008
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Phone No.: (408) 874-7171
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OR ACCOUNTING USE ONLY:
rganization :
und/Subclass:
ccount/Program:
56304323
0001/10000
7295/0
COUNTY OF FRESNO
ATTEST:
airperson of the Board of
he County of Fresno
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno, State of California
By: &~f'C\ 6J~Cl{>
Deputy
3
Revised Exhibit A-1
Page 1 of 18
Children/Youth Assertive Community Treatment Program
Scope of Work
ORGANIZATION: Uplift Family Services, Inc. (formerly EMQ Families First, Inc.)
ADDRESS: 1630 E. Shaw Avenue, Suite 150, Fresno, CA 93710
SERVICE: Assertive Community Treatment – Mental Health and Community Support
Services
CONTACT PERSON: Marilyn Bamford, Executive Director, Central Region
mbamford@upliftfs.org
(559) 446-3054
CONTRACT PERIOD: July 1, 2013 – December 31, 2018
CONTRACT AMOUNT: FY 2013-14 $1,607,418
FY 2014-15 $1,607,418
FY 2015-16 $1,607,418
FY 2016-17 $1,607,418
FY 2017-18 $2,429,802
FY 2018-19 (6 Months) $1,214,901
I. SCHEDULE OF SERVICES:
Uplift Family Services (CONTRACTOR) staff shall be available to provide services to clients 24 hours a day,
seven (7) days a week.
II. TARGET POPULATION:
Participation for Children/Youth – Assertive Community Treatment (ACT) program is for children and youth,
ages 10 to 18 years old at the time of program entry, with serious emotional disturbances and must have at
least one diagnosis from the most recent version of the Diagnostic and Statistical Manual (DSNM) of Mental
Disorders in accordance with the ACT Model. CONTRACTOR will provide intensive mental health services for
up to 160 children/youth each 12 month period with full fidelity to the ACT Model described in the National
Program Standards for ACT Teams. Additionally, the ACT program is expanded to assess and provide
services to caregivers of youth receiving ACT services, as needed, to positively impact the wellness and
recovery of participating youth. Youth participating in the program are referred by the Fresno County
Adolescent Behavioral Health Court, COUNTY’s Department of Behavioral Health—Children’s Mental Health,
Child Welfare Services, and Schools.
III. CHILDREN/YOUTH ASSERTIVE COMMUNITY TREATMENT (ACT) SERVICES PROGRAM:
CONTRACTOR will provide Fresno County’s ACT services for children and youth in the context of a
collaborative, integrated system that includes all mandated direct services and a wide range of community
partnerships and resources. In addition, CONTRACTOR will be in compliance with Fresno County’s RFP
#952-5101, the National Program Standards for ACT Teams, and ACT guidelines established by the federal
Substance Abuse and Mental Health Services Administration to the extent that the modification and adaptation
for youth and the funding allows.
The proposed model encompasses evidence-based practices proven to be effective for children and youth
impacted by serious emotional disturbances (SED) and behavioral issues and in or at risk of involvement with
Child Welfare, Juvenile Justice and Behavioral Health Court. Services will be provided in a continuum of care
model by three multidisciplinary teams of professionals and consumer/family member specialists working
Revised Exhibit A-1
Page 2 of 18
together with the children, youth and families in a Full Service Partnership model. Multi-cultural and multi-
lingual team members provide the majority of the treatment, rehabilitation, and support services children and
youth need to achieve treatment goals. Services are individually tailored to address each client’s age and
developmental stage, preferences, and identified goals. The approach emphasizes relationship building and
active involvement in assisting individuals with severe and persistent mental illness to make improvements in
functioning, better manage symptoms, achieve individual goals, and maintain optimism.
Each team consists of a qualified leader (Clinician II) who directs staff from the core mental health disciplines,
a Family Specialist who has been a consumer or family member, an Addiction Counselor, an
Education/Vocation Specialist, a Clinician I, and a contracted Psychiatrist for direct and on-call services 24
hours a day, seven days a week to provide intensive services. Multiple contacts may be as frequent as two to
three times per day, seven days per week, and are based on child/youth’s need and a mutually agreed upon
plan between the client and ACT staff. All team members share responsibility for addressing the needs of all
children and youth requiring frequent contact and are prepared to ensure continuity and timeliness of care.
Cross-training and daily case staffing among and between team members when indicated will be on an
ongoing basis to ensure that the youth’s needs can be met by someone familiar, rather than by referral to new,
unknown staff providers.
The ACT teams deliver services in community locations most comfortable for the youth and family. The
majority of all services will be provided outside program offices in the youth’s most natural environment. Home
and community-based services encourage client engagement and participation and can address day-to-day
issues youth normally encounter in their own living and educational settings.
Based on the intake and assessment information gathered by CONTRACTOR or provided by the Behavioral
Health Court (BHC), children and youth accepted into the program and their families receive the full range of
available services to assist them in achieving desired outcomes, including decreased re-entry into foster care
placement, detention, and hospitalization. Individualized service plans may include assessment and treatment
modalities for mental health and co-occurring substance use disorders; inclusion of the psychiatrist for clinical
services, medication evaluation, and management; and social support services such as assistance with basic
needs, education and/or vocational support, socialization, interpersonal skills, health and hygiene counseling,
assistance with access to primary health care, mentoring, tutoring, and role modeling as appropriate.
Resources for emergency housing are available where needed, including housing in rural areas if appropriate
for the child or youth.
Services will be tailored to meet the specific demographic and social needs of the target population. All service
planning must take into consideration age, gender, sexual orientation, language, culture, social issues (e.g.,
parenting and human sexuality), academic or employment status, medication management, substance abuse,
and peer relationships, as appropriate for the youth and family. Pregnant and parenting youth will be
connected to health care, child development training, and child care as needed. Transportation to service
resources, assistance with financial and legal issues, and planning for transition to stable living in a home
setting are also integral components of the service plan.
Specific interventions for each child and youth will be strength-based and client driven, and focused on stability
in the community and achieving the goals identified as desirable by the youth and family. Service delivery will
be flexible and can be modified quickly if needed to respond to the youth’s changing needs. Evidence-based
practices such as Managing and Adapting Practices and Trauma-Focused Cognitive Behavioral Therapy will
be utilized with each client, as appropriate. As training funding becomes available, CONTRACTOR will
continue to utilize its currently certified trainers or seek outside certified trainers to further develop and enhance
the ACT teams’ skills.
Referrals of youth diagnosed with or exhibiting severe emotional disturbances will be accepted from several
sources, including partnerships with Fresno County Behavioral Health Court (BHC), Juvenile Probation, school
districts, and the Departments of Behavioral Health and Social Services. Admission and discharge criteria, all
service planning, and delivery will be consistent in quality, timeliness, appropriateness, and duration for all
Revised Exhibit A-1
Page 3 of 18
children and youth, regardless of referral source. Service duration is determined by the individual’s needs and
progress. Each youth and family participates in graduated supports, services, and interventions as necessary
during the course of supervision to address violations of probation and/or deterioration of a youth’s mental
health. Interventions may include evidence-based community services such as medication review and
assessment, brief custody and/or electronic monitoring commitments, community service, weekend work, and
if necessary, inpatient psychiatric treatment.
CONTRACTOR has extensive experience serving SED youth and their families through its Fresno County ACT
Program, other mental health programs, Wraparound, foster care, and transitional housing. Assertive
Community Treatment is an empirically grounded, well documented and highly successful family intervention
for at-risk children and youth. The overall project goals, activities, and demonstrated outcomes include but are
not limited to:
• Assisting SED youth and their families in building wellness, recovery, and resilience skills;
• Reducing foster care, incarceration, and hospitalization recidivism rates;
• Increasing school attendance rates;
• Effectively serving children and youth with Conduct Disorder, Oppositional Defiant Disorder,
Disruptive Behavior Disorder, substance abuse disorders, and delinquent/violent behavior; and
• Interrupted escalation into more restrictive, higher cost services.
A. PROGRAM SPECIFICATIONS
1. Service Intensity and Capacity:
a. Staff to client ratio: At full capacity, the ACT Program has three teams; each team is responsible
for 40 children and youth. Each team is staffed with 5 FTE, with a standard one-to-eight staff-
to-child/youth ratio set to ensure that capacity and workload do not jeopardize child/youth
services.
b. Frequency and type of client contacts: Access to treatment, rehabilitation, and support services
is available 24 hours a day, seven days per week. Service contacts vary in intensity and
frequency to meet the child/youth’s changing needs for support in community settings. Service
levels are modified as needed to maintain an effective level of child/youth contacts. The service
plan may require multiple contacts each week with children and youth experiencing severe
symptoms, trying a new medication, experiencing a health problem or serious life event, trying
to go back to school or starting a new job, making changes in living situation or employment, or
having significant ongoing problems in daily living. Multiple contacts may occur as frequently as
two to three times per day, seven days per week, dependent upon child/youth need and a
mutually agreed upon plan between child/youth and program staff. Each child/youth receives at
least the minimum number of visits needed to ensure stability and safety, and to support
continued progress toward treatment goals. Team members share responsibility for addressing
the needs of all children/youth requiring frequent contact, ensuring that the child/youth always
has access to someone familiar with his/her needs and situations.
Child and youth contact locations vary, dependent upon service needs. Some activities may
occur at the CONTRACTOR site. Examples might include group therapy, peer support
meetings, psychiatric appointments, or personal and interpersonal skills classes. Other direct
contacts more commonly occur at the child or youth’s home, school, or preferred neighborhood
location such as a park or local restaurant, depending upon the child and youth’s comfort and
convenience and the purpose of the contact. Where appropriate, contacts may also be made by
phone.
2. Staff Requirements: Uplift Family Services maintains stringent background and professional
references research to assure that each employee hired meets or exceeds the standards
Revised Exhibit A-1
Page 4 of 18
expected for the job classification. COUNTY must approve the combination of education and
experience. The requirements for key ACT clinical positions are summarized below.
a. Clinical Program Manager
i. Education: Master's degree in a related field.
ii. License: Appropriate license to practice as a Licensed Clinical Social Worker (LCSW) or
Marriage Family Therapist (LMFT) in the State of California.
iii. Experience: two to four years in related work.
iv. Must meet the California Board of Behavioral Science (BBS) requirements to provide
clinical oversight and supervision.
b. Mental Health Clinician II: Serves as Team Leader
i. Education: Master of Arts or Science degree in a Social Science such as Psychology or a
Health Science related field.
ii. May require two or more years of experience working with children, youth, young adults
and families in a therapeutic environment (must meet specific county requirements.)
iii. License: Appropriate license to practice as a Licensed Clinical Social Worker or Marriage
Family Therapist in the State of California preferred.
iv. Experience: Community-based with Medi-Cal population preferred.
c. Mental Health Clinician I
i. Education: Master’s Degree.
ii. License: If unlicensed must be a registered intern with the Board of Behavioral Sciences
and receiving appropriate clinical supervision.
iii. Experience: At least two years of experience working with youth, young adults, and
families in a therapeutic environment.
d. Addiction/Prevention Counselor
i. Education: Bachelor’s degree or higher in Psychology, Counseling, or Social Work.
ii. License/Certification: certified drug and alcohol counselor preferred.
iii. Experience: Two to four years of related experience, or an equivalent combination of
education and experience working with youth or young adults with co-occurring disorders.
e. Education/Vocation Specialist
i. Education: Bachelor of Arts or Science degree.
ii. Experience: Two years in an education or vocational setting with children and youth.
f. Family Specialist
i. Education: Bachelor of Arts or Science degree.
ii. Experience: Six months, one year, or two years of experience working with SED children
required, dependent upon contract, or an equivalent combination of education and
experience.
g. Psychiatrist (subcontracted)
i. Education: Doctoral degree.
ii. License: California medical license as a physician in the State of California. Board
certified in adolescent and child psychiatry preferred.
iii. Experience: Treatment strategies, behavioral management approaches, and medication
management.
In addition to clinical positions, each team is supported by appropriate management and executive
oversight, and administrative support for clerical and outcome and evaluation reporting.
Psychiatrist time will also be utilized to provide medication management and support.
Revised Exhibit A-1
Page 5 of 18
3. Staffing Pattern: CONTRACTOR is experienced with the complexities of ensuring child and youth
access to services 24 hours per day, 7 days per week, including holidays. Through its Fresno ACT
and other community based mental health programs, CONTRACTOR has established effective
policies, practices, and personnel guidelines that support appropriate levels of response for
children, youth, and families at all times.
4. Job Classifications and Responsibilities: The ACT teams have written policies and procedures
guiding supervision of all staff providing treatment, rehabilitation, and support services. The Clinical
Program Manager assumes administrative and clinical responsibility for supervising and directing all
staff on the teams. Supervision and direction consists of individual supervision during child/youth
contacts and performance review, participation in staff meetings to review and assess staff
performance, and provide direction regarding individual cases, and assessment of clinical
performance. Each team member has a specific role and assigned responsibilities within the team
structure. The ACT team approach is based on the concept that many, if not all, team members
share responsibility for addressing the needs of all children and youth requiring ACT services.
B. PROGRAM ORGANIZATION AND COMMUNICATION
1. Planned hours of operation and staff coverage: ACT teams are available to provide treatment,
rehabilitation, and support activities seven days per week, which entails:
• Staggered staff starting times to provide direct services at least 12 hours per day on
weekdays.
• Regularly scheduling staff to work one 8 hour shift each weekend day and every holiday.
• Regularly scheduling mental health professionals for on-call duty to provide crisis and other
services during the hours when staff are not scheduled.
• Team members with experience in the program and skilled in crisis intervention procedures
are on call and available to respond to children and youth by telephone or in person.
• Regularly arranging for and providing psychiatric backup during all hours the psychiatrist is
not regularly scheduled to work. If availability of the ACT psychiatrist during all hours is not
feasible, alternative psychiatric backup is arranged.
2. Staff communication and planning activities: The ACT teams conduct daily organizational staff
meetings at regularly scheduled times, maintain written daily logs of child and youth identification,
and provide brief documentation of each child/youth’s status for the prior 24 hours. Detailed logs
provide a continuous roster of children/youth in the program, service contacts, and concise
behavioral description of each child/youth’s needs on any given day. The teams maintain weekly
child and youth schedules for all treatment and service contacts to fulfill the goals and objectives in
the child/youth’s treatment plan. The teams develop daily staff assignment schedules from the
weekly child and youth schedules. During the daily organizational and treatment planning meetings,
the teams assess the day-to-day progress of all children and youth, revise treatment plans as
needed, plan for emergency and crisis situations, and add service contacts to the daily staff
assignment schedule per the revised treatment plans.
3. Assertive engagement mechanisms: The ACT teams deliver services in community locations most
comfortable for the child/youth and family. The majority of all services are provided outside
program offices, in the child/youth’s most natural environment. Home and community based
services encourage child/youth engagement and participation, and can address day-to-day issues
the child/youth normally encounters in his/her own living and educational settings. These settings
may include leisure and recreational sites such as parks, shopping malls, and churches. The intent
is to actively provide psychosocial services where the child/youth need to use those services, rather
than in an institutional setting with little relevance to the child/youth’s normal environment.
CONTRACTOR uses several other mechanisms to engage and retain children and youth in the
Revised Exhibit A-1
Page 6 of 18
ACT program:
• The “no eject, no reject” policy has been implemented for ACT to assure that children and
youth continue to participate regardless of the complexity and frequency of high-intensity
service needs.
• Frequency of contact maintains close connections and strengthens the relationship between
the ACT team and the children and youth.
The ACT team approach and 24/7 availability ensure that children and youth can reach someone
with whom they are familiar at any time a need arises, keeping them engaged at times when crisis
situations may put them at risk of dropping out of the program.
4. Staff education and training: CONTRACTOR has a strong agency-wide staff training program that
includes topics such as child and youth assessment and engagement skills, co-occurring disorders,
gender awareness and sensitivity, and culture-specific topics such as sexual orientation and identity
issues. Specialized training in evidence-based practices such as Managing and Adapting
Practices, and Trauma Focused Cognitive Behavioral Therapy is provided to program staff as
needed for each of CONTRACTOR’s programs.
Cultural competency is a core component of all CONTRACTOR training programs. In addition to
specific training modules, an agency-wide commitment to culturally competent services is infused
throughout all programs at every level. CONTRACTOR has established a Cultural Competence
Plan that ensures ongoing fidelity to cultural competence values and practices.
The ACT team members receive focused training on such topics as the Assertive Community
Treatment model, co-occurring mental health and substance abuse disorders, medication
monitoring, Wraparound techniques and approaches, social development and functioning, family
and social relationship building, and dealing with high-risk behaviors. Team members also receive
training related to Mental Health Services Act (MHSA), Full Service Partnerships (FSP), and
interacting with Behavioral Health Court and other child welfare and criminal justice systems.
To ensure model fidelity, CONTRACTOR uses the National Standards and ACT implementation
materials developed by SAMHSA. “Implementing Evidence-Based Practices Project Assertive
Community Treatment Workbook”1, to develop a step-by-step training plan, implementing the
program as an effective evidence-based practice. The outline below illustrates basic ACT training
modules. CONTRACTOR will review and update a detailed training plan and submit it to Fresno
County for review, if requested. The schedule will be modified as needed to include all team
members.
Annually, and as staff are hired, the following trainings are provided:
• Emphasis on the ACT model and vision, organizational tools, team/organizational
psychology, philosophy of child and youth based services, integration of roles/team
dynamics, assessment and individualized treatment planning.
• General services, organizing admissions, individualized treatment planning, daily teamwork,
medication set-up, pharmacy issues, education, vocational and employment issues.
• Individualized treatment planning and education, vocational and employment issues.
• Evaluation, troubleshooting, and quality improvement.
• Mentoring to provide support and reinforce team attitudes, knowledge and skills related to
ACT development.
• Full implementing and use of ACT organizational tools, treatment, rehabilitation, and
1 Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, and Robert Wood Johnson
Foundation, 2003
Revised Exhibit A-1
Page 7 of 18
support. Emphasis continues on organization of services, integration of roles, team building,
individualized treatment planning, and education and employment services.
• Emphasis on evaluation, troubleshooting, and quality improvement.
C. CLIENT-CENTERED ASSESSMENT AND INDIVIDUALIZED TREATMENT PLANNING
1. Initial assessment and comprehensive assessment: The ACT intake and assessment process is
based on existing agency standards for comprehensive assessment, incorporating psychiatric and
treatment information provided by BHC. All written information provided by the BHC becomes part
of the child/youth’s permanent CONTRACTOR record, available to all team members for service
planning.
CONTRACTOR uses a full-scope intake and assessment process to identify the specific needs of
every child and youth referred. Children and youth, as appropriate to age, are full partners in
determining preferences, service modalities, and desired goals, as are their family members.
Planning includes accommodations for culture, language, gender, and age. CONTRACTOR’s child
and youth assessment processes evaluate the needs and strengths of each child/youth and his/her
family members when appropriate. Every step of engagement, planning, and implementation is
based on the individual needs and goals identified by the child/youth and family members during
the self-assessment and planning process. Using the Client Data Sheet, the Fresno County Mental
Health Plan assessment, and a Safety Plan, the ACT team members develop and record the
clinical and social functioning information needed to support comprehensive Individualized Child
and Family Treatment Plan (ICFP).
During the initial assessment, the BHC evaluations and treatment plans are reviewed with the
family. If there are indications that the plan may need to be modified, the team leader meets with
the BHC team to review and discuss options. CONTRACTOR minimizes duplicative interviewing by
entering the demographic and clinical data provided by BHC into the online TIER client record as an
integral part of comprehensive treatment planning.
As soon as possible after intake, the ACT team leaders and designated team members complete a
multi-layered assessment that addresses the full scope of youth and family needs and issues,
including psychiatric history, physical health, substance and alcohol abuse history, education and
employment, social development and functioning, activities of daily living, and family structure and
relationships. The assessment forms the basis for the individualized service plan.
Research-proven and state-approved outcome measurement tools track and evaluate the
outcomes of treatment and support services, including the Child Adolescent Needs and Strengths
(CANS) survey. In addition, CONTRACTOR implements the Clinical Condition and Quality of Life
measurement through the collection of core date elements. Results from each child/youth’s
completed forms are entered into the electronic health care system (TIER) system.
2. Individualized treatment plans: All treatment planning with children and youth and their families is
based on the client-centered, recovery-oriented mental health service delivery characteristics
established by the National Program Standards for ACT teams:
• Serve children and youth with severe and persistent mental illnesses that are complex, have
devastating effects on functioning, and, because of the limitations of traditional mental
health services, may have gone without appropriate services.
• Deliver services through teams of multidisciplinary mental health staff who provide the
majority of the treatment, rehabilitation, and support services children and youth need to
achieve their goals.
• Individually tailor services to address the preferences and identified goals of each
child/youth.
• Provide mobile services in community locations to enable each child/youth to feel
Revised Exhibit A-1
Page 8 of 18
comfortable in his/her home, neighborhood, and school; and to allow each child/youth, as
appropriate to his/her age, to find and live in his/her own residence, and find and maintain
educational or employment efforts in their chosen communities.
• Deliver services in an ongoing, rather than time-limited, framework to aid the child/youth’s
process of recovery and stabilization in the community. The service plan includes
child/youth-driven goals and milestones to support progress toward discharge and
connection with community resources. Timeframes for progressive achievement of
increasingly independent skill levels are determined by the child/youth’s needs, desires, and
abilities.
The ACT ICFP begins with information provided by the BHC and/or the results of CONTRACTOR’s
comprehensive intake and assessment process. Each child/youth and family has input into the
services and supports desired and how such care is delivered, which enables them some control
over service decisions. Treatment plans are tailored to child/youth and family strengths, desired
treatment outcomes, and cultural and linguistic preferences.
Treatment plans are specific, with service types, intensities and frequencies designed to achieve
the desired outcomes. The ICFP identifies issues/problems; sets measurable short- and long-term
goals; and establishes specific approaches and interventions for the child/youth to meet goals,
improve capacity to function in the community, and achieve the maximum level of recovery
possible. Planning for integration into and reliance on home, neighborhood and community
resources is developed with respect for the child/youth’s desires, skills, interests, and abilities.
Flexible plans include crisis and safety awareness and resources; clear delineation of roles and
responsibilities; and definition of mechanisms for rapid response to changing service needs.
Each treatment plan is detailed and tailored to accomplishing specific tasks, focused on keeping the
child/youth out of incarceration, out of hospitals, and maintaining maximum function in their schools,
jobs, and communities. All ACT team members, regardless of their specific discipline or expertise,
become familiar with the child/youth, the family, and with each other to share knowledge, provide
continuity in service delivery, and ensure that all service delivery occurs within the context of the
treatment plan goals. CONTRACTOR values support doing whatever it takes, wherever and
whenever it’s needed to ensure that children/youth and families receive the most effective services
at the times and in the places that will meet their specific needs. An intensive, comprehensive ACT
program delivers treatment and rehabilitation services and case management. ACT services differ
significantly from traditional case management models, and provide the following features:
ACT Service Delivery Model
• Staff to child/youth ratio of 1 to 8;
• All services provided directly by team members;
• Team members share responsibility for all individuals;
• Type and intensity of services can be varied modified easily;
• Team members provide ANY service an individual needs, that would support the treatment
goal;
• Team is responsible for ensuring individuals receive services they need even if they are
difficult to engage, get arrested, or are hospitalized;
• If a team member goes on vacation or quits, service plans are continued by other team
members who are known to the individual; and
• Team discusses changes to an individual’s status daily and adjusts treatment as needed.
3. Intake timeline and procedure: CONTRACTOR makes initial contact with child/youth within two
business days of receiving initial referrals. Referrals are distributed between the ACT teams on a
rotating basis, unless available information indicates that the child/youth and family could benefit
from specific expertise available on one team or another. Every effort is made to schedule an
intake and orientation appointment with the team leader, the child/youth, and the family within the
Revised Exhibit A-1
Page 9 of 18
first five days of initial contact. During intake, a time and location is scheduled for the child/youth
and family to meet the rest of the team to develop a comprehensive assessment and service plan.
Information provided to the child/youth explains the ACT program, describes the team concept,
clarifies team and child/youth roles and expectations, and provides emergency contact information
to the child/youth and family.
4. Timely provision of services: Initial contact, assessment and development of service plans occur
within the first seven business days after referral, dependent upon the family’s availability. In urgent
situations, children and youth are connected to a team member for intervention and support even
before a service plan is developed, using information from the referral as the basis for a temporary
service plan. Service contact frequency and timing are driven by the child and youth’s needs, goals,
and desires, with no less than three contacts per week.
5. Managing crisis or other participant emergencies: The ACT program model uses multiple resources
to respond to crisis and emergency issues. On-call team members are available by phone at all
times to respond if the primary team contact is not available. Emergency contacts are made via
telephone or face-to-face visits, as deemed appropriate by the responding team member.
Team members are familiar with all local emergency physical health and psychiatric emergency
services, including urgent care clinics, hospitals, and the County-operated Youth’s Crisis,
Assessment, Intervention, and Resolution facility. CONTRACTOR maintains a budgeted flexible
child and youth services fund to respond quickly to basic need emergencies such as temporary
housing, transportation, food, clothing, school supplies, etc. Each team member has access to the
fund to quickly respond to crisis situations.
6. Transition and community reintegration: Discharge planning includes planning for future stability in
the community with decreased hospitalization, increased school attendance and academic
achievement, and/or juvenile justice recidivism; and occurs during intake, assessment and service
development. Each team, with the child/youth and family as fully participating partners, defines
transition and reintegration goals, develops measurable milestones and strategies for achievement,
and identifies resources and services likely to support the child/youth’s progress toward recovery
and stability.
The service delivery process includes education about available community resources, assisting
and mentoring the child/youth and family in learning how to access those resources, and
establishing community-based relationships that will continue to serve and support the child/youth
and family after reintegration. Planning includes long-term follow-up to monitor and assure
sustained improvement, with the frequency and intensity of contacts decreasing as the child/youth’s
ability to function independently increases. The team ensures that the youth and family are
connected to adequate sources of assistance and support before terminating formal contacts.
A. EXPLICIT ADMISSION AND DISCHARGE CRITERIA
1. Admission Criteria: CONTRACTOR accepts and will continue to accept two referral categories,
which may have varied admission criteria dependent upon the referral source.
a. BHC Team Referrals: Referrals from the team will have been evaluated for compliance with
ACT admission criteria prior to referral to the program. Each referral includes the BHC mental
health assessment, treatment plan, and signed consent forms. Based on the BHC team’s
assurance that youth referred to the program meet the national ACT standards,
CONTRACTOR’s ACT Clinical Program Manager (CPM) reviews the referral information for
appropriateness for the particular child/youth. If necessary, the CPM confers with the BHC
team to address any questions or concerns.
Revised Exhibit A-1
Page 10 of 18
b. Alternative Referral Sources: For referrals received from other sources, such as County of
Fresno Child Welfare Services, Children’s Mental Health, schools, and the District Attorney’s
office, the CPM ensures compliance with National Act Standards defining admission criteria,
adapted to serve children and youth:
Children and youth with severe and persistent mental illness listed in the DSM IV that seriously
impair their functioning in community living. Priority is given to children/youth experiencing their
first psychotic breaks, as well as those with schizophrenia, other psychotic disorders (e.g.,
schizoaffective disorder), and bipolar disorder as these illnesses more often cause long-term
psychiatric disability. Eligibility of children and youth with other psychiatric illnesses is
dependent on the level of potential long-term disability. Individuals diagnosed with co-occurring
substance abuse disorders will be accepted into the ACT program if they meet the mental
health criteria described above.
c. Children and youth with significant functional impairments as demonstrated by at least one of
the following conditions:
i. Significant difficulty consistently performing the range of practical daily living tasks required
for basic functioning in school, work, or the community.
ii. Significant difficulty maintaining consistent school attendance, employment and/or self-care
(including child-care tasks and responsibilities for parenting youth) at a self-sustaining level.
iii. Significant difficulty maintaining personal safety.
d. Children and youth with one or more of the following problems, which are indicators of
continuous high service needs:
i. High use of acute psychiatric hospitals or psychiatric emergency services.
ii. Intractable severe major symptoms associated with mental health issues.
iii. Coexisting substance abuse disorder of significant duration.
iv. High risk or recent history of criminal justice involvement (e.g., arrest, incarceration).
v. Significant difficulty meeting basic survival needs, homelessness, or imminent risk of
becoming homeless.
vi. Residing in an inpatient or supervised community residence, but clinically assessed as
being able to maintain functioning in a more independent living situation if intensive services
are provided, or requiring a residential or institutional placement if more intensive services
are not available.
vii. Difficulty effectively utilizing traditional office-based outpatient services.
2. Discharge Criteria: The Youth ACT model is based on development of child/youth-driven treatment
goals and services to help the child/youth and family move progressively toward decreased
dependence on ACT team support. Due to the individual needs of each participant involved with
the ACT program, the progress of a child/youth cannot be projected on a preset timeline, but rather
must occur based on each individual’s progress and achievement of specific treatment goals.
When the participant’s acuity of mental health symptoms have stabilized over a significant period of
time and the family can obtain needed services in the community, the team will work with the
child/youth and family to develop a plan for transitioning to case closure.
a. BHC Team Case Closures: Discharge occurs when the BHC team, the ACT team, and the
child/youth and family mutually agree that community-based services will be sufficient to
maintain safety and stability because the child/youth exhibits the indicators of discharge (see
item 2 below).
b. Alternative Referral Source Case Closures: The ACT teams follow clinical standards of care
governing quality and continuity to assess readiness for discharge. A plan for transitioning to
discharge is developed when the child/youth:
i. Successfully reached individually established goals for discharge.
Revised Exhibit A-1
Page 11 of 18
ii. Successfully demonstrated an ability to function in all major role areas (e.g., work, social,
self-care) without ongoing assistance, with supportive community services if needed.
iii. Moves outside the geographic area of ACT’s responsibility. In such cases, the ACT team, to
the extent possible, assists with the transfer of mental health service responsibility to an
ACT program or another provider within the service area where the child/youth is relocating.
The ACT team makes every effort to maintain contact with the child/youth until this service
transfer is implemented. Every effort will be made for a six month follow up of clients after
discharge.
iv. Declines or refuses further services and requests discharge, despite the team’s best efforts
to develop an acceptable treatment plan with the child/youth.
B. REQUIRED SERVICES
1. Service Coordination: Policies and procedures are in place to ensure consistent communication and
service coordination between team members to integrate a full range of services for each
child/youth into an individualized service plan. Team meetings are held regularly and as needed to
address changes to the child/youth’s circumstances. The ACT team members will coordinate
service delivery with other community-based providers that may provide services to ACT enrollees
to minimize duplicative services, ensure compliance with service delivery standards, and avoid
imposing conflicting service or time demands on the child/youth. Additionally, CONTRACTOR will
implement information sharing guidelines to ensure consistency with County, State, and Federal
rules regarding individuals’ rights to privacy.
2. On-Call Crisis Assessment and Intervention: CONTRACTOR has an existing On-Call system to
provide crisis intervention services to children/youth and their families after regular work hours and
on weekends. The system has been enhanced to include a range of accessibility, ranging from
telephone “warm line” support to face-to-face contact and home visits, to assess and de-escalate
crises with appropriate interventions and ensure child/youth and family safety. All children/youth
and families in the program are given the access number to reach On-Call staff, 24 hours a day,
seven days a week. The On-Call system uses On-Call treatment team staff and/or the Clinical
Program Manager to provide clinical support.
3. Symptom Assessment and Management: The services described above are among the core
components of CONTRACTOR programming for all children and youth served. All team members
share responsibility and accountability for each child/youth on their caseload, and are given the
same training regarding mental illness and medications. Team members learn to observe,
understand, and record signs and symptoms of the child/youth’s mental illness and provide
information to clinical staff to assist with assessment of response to treatment. CONTRACTOR
staff will routinely monitor the effects of medication in every contact between a treatment team
member and the child/youth, and provide psychological support is one of the underlying foundations
of treatment in an ACT model, infused into every aspect of the treatment teams’ roles and
responsibilities.
4. Psychiatric services (i.e. medication, medication management): The ACT program will provide for
Psychiatrist services to treat children and youth in the program who are receiving psychotropic
medications, as well as those in need of medication evaluations and/or monitoring. The Psychiatrist
provides medication education and management, including observed administration if needed, to
children/youth and families, as well as training to ACT team members regarding medication side
effects and symptoms.
5. Dual Diagnosis (mental health and substance abuse services): The ACT program provides an
integrated approach to co-occurring disorders, recognizing that the treatment must be inclusive,
focused on harm reduction and supportive of sobriety. One of the ACT Addiction Counselors will be
certified by the CA Association of Alcoholism and Drug Abuse Counselors, utilizes the Addiction
Revised Exhibit A-1
Page 12 of 18
Severity Index screening to assess the client’s level of addiction, and makes recommendations to
the assigned Mental Health Clinician. The Addiction Counselor provides therapeutic addiction
treatment as indicated by the Clinician’s Plan of Care, including group therapy. The Addiction
Counselor also provides prevention classes for clients and families and trains team members to
understand, model, and reinforce the coping skills needed to achieve periods of abstinence.
Children/youth and their families are encouraged to plan for and participate in sober recreational
activities during leisure time to build new diversion skills and form healthy social relationships.
6. Individual and Group Therapy: Therapeutic treatment services may be provided in a group process
or on an individual face-to-face basis. Research indicates that group therapy is more effective for
children and youth; however, individual therapy is provided as the need is indicated. Specific
interventions are determined through the use of evidence-based and best practices, including
Trauma Focused Cognitive Behavioral Therapy, Managing Adaptive Practices, and the ACT model.
7. Case Management: The typical goals of case management (e.g., preventing hospitalization,
improving quality of life, and improving client functioning), as well as some typical case
management activities (e.g., service planning, assessment, and advocacy) overlap with those for
ACT programs. However, the methods and resources to achieve these ends differ significantly.
Unlike traditional case management, in which clients are linked to other service providers rather
than directly intervening, ACT team members provide direct case management as part of the
treatment and supportive services delivery process. Case management services help the
child/youth and family locate and link with services in the community that promote ongoing mental
health.
8. Rehabilitation and family support: Each ACT team includes a Family Specialist who is familiar with
public service programs. Through coaching, mentoring, and role modeling, the Family Specialist
assists the child/youth and family members in building or rebuilding the skills needed for effective
day-to-day functioning. The Family Specialist builds familial alignment and utilizes the strengths of
children/youth and others to assist in the implementation and achievement of goals and outcomes.
CONTRACTOR’s network and knowledge of available resources throughout the county helps to
develop a support network, as well as the self-confidence and self-sufficiency of the child/youth and
family, preparing them to function successfully in their community upon discharge. CONTRACTOR
tracks information on the use of referral services during treatment.
9. Social/Interpersonal Relationship and Leisure-Time Skill Training: CONTRACTOR fully understands
the importance of normative social relationships and recreational activities and ensures that each
enrolled child/youth has appropriate opportunities to engage in community based activities that
foster peer to peer skill building activities. Using relationship building techniques and establishment
of an open and trusting environment, enrolled children/youth are encouraged to participate in
healthy group dynamics within various settings including family homes, schools, parks, and
recreation centers. Team members assist, coach, and support children/youth and their families as
they participate in activities, and use modeling and role playing to practice possible interactions with
others, including examples of conflict resolution and activities to develop and strengthen family
relationships, self-expression, and self-esteem. As with other aspects of personal and social
learning, team members assist participants to first understand, then practice, and finally perform the
planned activity.
Daily and weekly schedules of activities include ample opportunities for child/youth-driven free time
and development of planning for participation in activities of interest. The child/youth’s and family’s
spiritual and religious preferences, identified in the initial assessment, are respected and valued,
and the child/youth and families will choose to participate in related activities. CONTRACTOR’s
collaboration with other agencies expands opportunities for program participants to experience
educational, social, and recreational activities beyond the scope of funded services.
Revised Exhibit A-1
Page 13 of 18
10. Peer Support Services: The Family Specialist works directly with each child/youth, and their parents
or other significant persons, at a peer level to outline alternatives and predict consequences while
supporting good decision-making; fostering participation in healthy group dynamics within various
settings, including family homes, schools, parks and recreation centers, and treatment facilities; and
providing an open forum to express feelings and ideas when appropriate. The Family Specialist
builds familial alignment while working with the child/youth and family by utilizing their strengths to
assist in the implementation and achievement of goals and outcomes.
11. Support Services: CONTRACTOR understands the importance of ensuring that children/youth and
families have access to a full and comprehensive range of support services as they move toward
wellness and sustainable recovery. Each individualized care plan for enrolled ACT children and
youth includes a combination of services available by both the ACT team and other community
providers, as appropriate. For example, the ACT teams provide transportation to appointments and
scheduled activities as necessary, as well as emergency short-term housing through rental
assistance, housing vouchers, or accommodations in local hotels if needed. Support services
include, but are not limited to the following:
• Medical and dental services
• Safe, clean, affordable housing
• Financial support and/or benefits counseling
• Social services
• Transportation
• Legal advocacy and representation
Other services available through collaboration with other professionals include schools, juvenile and
adult probation, health providers, cultural and community organizations, and individuals who
provide specific services to meet individual needs. CONTRACTOR will have an established a
collaborative network that includes other non-profit organizations, faith-based groups, and grass-
roots organizations serving children, youth, transition age youth, adults, and families. These
relationships encompass the full range of services most likely to be needed by participating children
and youth and families. Collaborative partners may include, but are not limited to, the following:
• County Health and Human Services Departments
• Court Appointed Special Advocates
• Boys and Girls Club
• Employment and vocational training resources
• Workforce Investment Departments and One-Stop Centers
• County Independent Living Programs
• County Mental Health Services,
• City Police Departments
• Local schools, community colleges, and universities
• Drug and Behavioral Health Courts
• Substance abuse prevention and treatment services
• Health services providers
• Community food banks, emergency shelters, and transportation services
CONTRACTOR is already familiar with the full range of community services available in Fresno
County. In addition to maintaining its own directory of service resources, CONTRACTOR ensures
that all staff are familiar with the use of the county’s 211 information line, resource directories
maintained by the County library and Fresno Metro Ministry, and the internet-based Network of
Care website for Fresno County.
The ACT model of service delivery is based on staged development of independent function,
Revised Exhibit A-1
Page 14 of 18
encouraging increasingly responsible behavior as developmental stages allow.
Program staff are trained to build trusting relationships in an environment where change is
recognized as part of the journey to personal growth and development to encourage children, youth
and families in the program to accept and benefit from available services. Client and family
participants are active members of the team process, and help identify their own strengths, needs,
and life skills objectives. Program staff engage children/youth, assess their readiness for change,
and assist them in working through the stages of change. As service needs are identified and
incorporated into the individualized service, children/youth and families are guided to make their
own decisions about what services they need and where to access those services. Team members
serve as coaches in every aspect of service-seeking behavior to increase the child/youth’s
knowledge, security, and self-confidence; and henceforth assure that the child/youth learns to take
independent action.
12. Education: CONTRACTOR is fully familiar with meeting the school-related needs of enrolled
children and youth. Through the County of Fresno ACT, SB 163 Wraparound, and Foster Care
programs, CONTRACTOR will maintain relationships with the major school districts in the County,
as well as with Fresno City College and California State University, Fresno. During each initial
intake and assessment, the child/youth’s academic level and specialized needs are included as
integral components of the service planning process. The Education/Vocation Counselor assigned
to each ACT team provides direct supportive services where appropriate, consults with academic
and vocational institution representatives, and connects children and youth with any resources
needed to support the maximum level of educational achievement, including but not limited to the
following:
• Individualized Education Plan, special education, and alternative education support
• GED preparation and referral
• Secondary and post-secondary support including tutoring, career exploration, and financial
aid
13. Support and Consultation: Family involvement is often critical to the success of treatment; therefore,
collateral services which include family therapy, parent education, and coaching on appropriate
behavior, are provided. As part of intensive case management, children/youth and families are
referred or linked to community resources for peer support, self-help services, and information
resources.
Pregnant and parenting youth enrolled in the program are connected with health and social support
services, including private medical practitioners; public clinics; and local, public, and private social
service agencies to ensure adequate prenatal and delivery care, as well as child development and
parenting education. Team members offer assistance, counseling, and psychological support as
needed to serve the child/youth and family. They also serve as mentors and supportive advocates,
as appropriate, to work with parents in their efforts to establish or restore relationships with their
children, both those in their custody and those for whom they do not have custody.
14. Court Participation: CONTRACTOR is familiar with both juvenile and adult courts, including juvenile
dependency and delinquency courts, Behavioral Health Court, and Drug Court. ACT staff will have
working relationships with representatives in the previously mentioned courts, as well as with law
enforcement staff at Juvenile Probation. CONTRACTOR will participate in judicial proceedings,
including testimony when necessary, and meet all requirements for court appearances and written
reporting. For the purpose of serving ACT clients, one member of each ACT team will be
designated as liaison to law enforcement departments and all courts. Treatment schedules will
include mandated justice-related activities, transportation, and support.
IV. PERFORMANCE MEASUREMENT:
Revised Exhibit A-1
Page 15 of 18
CONTRACTOR will gather, collect, and submit Mental Health Services Act (MHSA) Full Service Partnership
data as required by the State Data Collection Reporting system and other data reports as requested by
COUNTY, such as the Annual Mental Health Advisory Board Data Report. These data will be submitted as
required and entered into a local database for internal reporting purposes.
Service satisfaction data will be collected for all cross-sectional mental health programs, as required by the
California Department of Mental Health, at two time periods across the agency for each twelve (12) month
period of the Agreement term. Additionally, the Youth Satisfaction Survey (YSS) is collected for each
child/youth six months post-entry to provide more detailed and relevant information regarding service
satisfaction over time. CONTRACTOR will also participate in the Performance Outcomes and Quality
Improvement (POQI) satisfaction survey.
CONTRACTOR will have a unit dedicated to providing outcome and evaluation information pertaining to the
services provided and clients served. CONTRACTOR will implement a core set of outcome measures,
permitting comparative and other analyses that add depth and value to the outcomes obtained by specific
programs. Measurement tools used will include the Child and Adolescent Needs and Strengths (CANS) and
indicators of system performance and child outcomes designed to assess whether children youth are in home,
in school, or at work and out of trouble. Such indicators will be used to track and report each enrolled
child/youth’s progress. In addition, these measurement tools allow CONTRACTOR and COUNTY to assess
effectiveness at child/youth and systemic levels.
CONTRACTOR’s electronic health record will be used to collect basic system level indicators, upon program
entry and discharge, of whether children/youth are in home, in school, or at work and out of trouble. Outcome
indicators allow the following factors to be assessed in 12 month time spans: frequency of incarceration
(probation involvement), frequency of hospitalizations, frequency of contacts with the Children’s Crisis
Assessment Intervention Resolution (CCAIR) Center; school attendance, school grades and performance,
employment, and living situations. Data will be routinely reported to program staff and agency leadership as a
part of ongoing continuous quality improvement, and to COUNTY on a fixed or variable schedule according to
COUNTY requirements.
The tables below summarize outcome measures used by CONTRACTOR. System Level Measures are
somewhat dependent on cross systems collaboration; whereas, Practice Level Measures capture data that are
often most directly linked to the work of the practitioner.
A. System Level Measures and Outcomes:
WHAT SOURCE WHEN
1. Living Situation:
a. Restrictiveness
b. Stability
c. Permanence
Recorded by
Clinician/Case Manager
Upon entry, at three month
intervals, and upon
discharge.
2. Educational Performance:
a. School Attendance
2. School Performance
Recorded by
Clinician/Case Manager
Upon entry, at three month
intervals, and upon
discharge.
3. Employment (when relevant):
a. Hours Worked
b. Length of Employment
Recorded by
Clinician/Case Manager
Upon entry, at three month
intervals, and upon
discharge.
4. Juvenile Justice:
a. Recidivism: arrests and citations
by type of offense
Recorded by
Clinician/Case Manager
Upon entry, at three month
intervals, and upon
discharge.
Revised Exhibit A-1
Page 16 of 18
B. Practice Level Measures and Outcomes:
WHAT SOURCE WHEN
1. Functioning, competence, and
impairment from caregiver,
child/youth, and clinician
perspectives; Child and Adolescent
Needs and Strengths (CANS)
Caregiver
Child/youth
Clinician
Upon entry, at three month
intervals, and upon
discharge.
At six month cross-sections
and six months post intake.
2. Satisfaction with Services (YSS) Child/youth
Bi-annual sample, at six
month intervals, and upon
discharge.
V. ADDITIONAL CONTRACTOR REQUIREMENTS:
CONTRACTOR shall:
A. Maintain facilities and equipment, and operate continuously with the number and classification of staff
required described under this Agreement and in Exhibit B-1. If CONTRACTOR does not have the
positions filled for these services as described in Exhibit B-1, CONTRACTOR shall notify COUNTY in
writing within fifteen (15) days of the vacancy and provide a plan of action to continue the current
level of services.
B. Provide Plans of Care that include all safety, emergency, and crisis procedures in the field and in
CONTRACTOR’s offices.
C. As related to Cultural Competence, CONTRACTOR shall:
1. Recruit and hire staff that have demonstrated experience working with the Latino, African American,
Southeast Asian, Native American, and other minority populations and have knowledge about the
culture of these targeted groups as well as other diverse communities.
2. Ensure staff attend annual trainings on cultural competency, awareness, and diversity as provided
by CONTRACTOR, or online via the County’s eLearning system. Staff shall be appropriately
trained in providing services in a culturally sensitive manner.
3. Ensure staff attend civil rights training as provided by CONTRACTOR, or online via COUNTY’s
eLearning system.
4. Hire bilingual staff. At a minimum, CONTRACTOR shall hire staff competent in Fresno County
threshold languages: Spanish and Hmong.
5. Secure the services of trained translators/interpreters as necessary. CONTRACTOR is encouraged
to subcontract with translators/interpreters proficient in additional languages common to Fresno
County, such as Cambodian, Russian, Arabic, Armenian, Punjabi, among others.
Interpreters/translators shall be appropriately trained in providing services in a culturally sensitive
manner.
6. Provide services by placing importance on traditional values, beliefs and family histories. Cultural
values and traditions offer special strengths in treating clients and this should help guide health care
messages and wellness and recovery plans.
7. Provide services within the most relevant and meaningful cultural, gender-sensitive, and age-
appropriate context for the target population.
Revised Exhibit A-1
Page 17 of 18
8. Develop plans to continually engage targeted populations.
9. Recruit and hire former client or family member with comparable experience to the child and family
receiving services as a significant portion of their staffing.
10. Ensure access to services is streamlined and available at times that are convenient for the targeted
population.
11. Distribute literature/informational brochures in threshold languages, at a minimum, and request
feedback in regard to improvements to access of care for culturally diverse communities.
12. Conduct an annual cultural competency self-assessment and provide the results to COUNTY.
Annual cultural competency self-assessment tools shall be reviewed by COUNTY and revised as
necessary to meet the approval of COUNTY.
13. Increase access to mental health services to target populations by providing services in
communities, as opposed to providing services at mental health service agency locations.
14. Promote system of care accountability for performance outcomes which enable children and their
families to live independently, work, maintain community supports, stay in good health, and avoid
substance abuse and incarceration.
15. Develop individual services and supports plans which are flexible and open to meet the unique
needs of the target population.
16. Collaborate with agencies that are recognized and accepted by the targeted populations.
17. Provide family support and the development of family partnerships, peer support for families, and
parenting support.
18. Establish culturally specific multidisciplinary treatment teams responsible for assuring and providing
needed services.
19. Provide supportive housing vouchers and referrals for safe, adequate, and affordable housing, as
identified in this Agreement.
20. Provide parenting groups that are conducted in the preferred language of the client/families.
21. Provide services with considerations for gender sensitive needs of clients/families, such as who is
the primary care giver, domestic violence, and women’s health issues.
22. Ensure staff are trained to keep an open mind and refrain from making inappropriate judgments on
clients/families.
23. Seek to hire and train staff and community stakeholders (i.e., consumers, family members, etc.)
who provide services to clients/families regarding appropriate methods and approaches to
delivering gender and age specific services.
24. Ensure that staff are hired based on local data and reflect the needs of the population to be served.
25. Maintain a cultural competence oversight committee and cultural competency plan to address and
evaluate cultural competency issues.
Revised Exhibit A-1
Page 18 of 18
D. Assume responsibility for client medication costs.
E. Maintain client treatment records according to all Federal, State, MHSA FSP regulations as it relates to
Health Insurance Portability and Accountability Act (HIPAA).
F. Ensure facility location is approved by COUNTY. COUNTY must be informed of new site locations in
writing and provide approval prior to use of the new site prior to use for services provided through this
Agreement.
G. Maintain site certification in accordance with Medi-Cal Organization provider status, and ensure Medi-
Cal billing is conducted in accordance with the Fresno County Mental Health Plan.
H. Provide housing and employment support services as stated in CONTRACTOR’s response to Revised
RFP No. 952-5101.
I. Log all complaints and grievances, and produce such logs upon COUNTY’s request.
VI. COUNTY RESPONSIBILITIES:
COUNTY shall:
A. Provide oversight, through its MHSA FSP Coordinator or designee, and collaborate with vendor and
other County Departments and community agencies to help achieve State program goals and
outcomes. In addition to contract monitoring of program(s), oversight includes, but is not limited to,
contract monitoring and coordination with the State Department of Health Care Services in regard to
program administration and outcomes.
B. Assist CONTRACTOR in making linkages with the total mental health system through regularly
scheduled meetings as well as formal and informal consultation.
C. Participate in evaluating the progress of the overall program and the efficiency of collaboration with
CONTRACTOR staff and will be available for ongoing consultation.
D. Provide technical assistance and demographic data to CONTRACTOR in relation to cultural
competency planning.
FTE %Admin.Direct Total
0001 5.00 25,624$ 128,120$ 128,120$
0002 3.00 30,763$ 92,289$ 92,289$
0003 4.00 17,261$ 69,044$ 69,044$
0004 3.00 20,078$ 60,233$ 60,233$
0005 2.00 18,842$ 37,684$ 37,684$
0006 1.00 27,769$ 27,769$ 27,769$
0007 2.00 35,552$ 71,104$ 71,104$
0008 0.50 23,809$ 11,902$ 11,902$
0009 0.28 42,984$ 11,821$ 11,821$
0010 3.49 31,458$ 109,788$ 109,788$
0011 -$
24.26 -$ 619,751$ 619,751$
-$
0030 38,228$ 38,228$
0031 MEDICARE 8,940$ 8,940$
0032 -$ 6,167$ 6,167$
-$ 53,335 53,335
-$
0040 -$ 21,656$ 21,656$
0041 -$ 14,406$ 14,406$
0042 -$ 145,093$ 145,093$
-$ 181,155$ 181,155$
854,240$
1010 42,328$
1011 6,380$
1012 -$
1013 1,793$
50,501$
1060 18,494$
1061 -$
1062 -$
1063 -$
1064 -$
1065 -$
1066 4,482$
1067 -$
1068 -$
1069 -$
1070 42,841$
1071 1,538$
1072 2,434$
69,788$
FACILITIES/EQUIPMENT EXPENSES:
Associate Director
EMPLOYEE BENEFITS:
Retirement
Workers Compensation
Health Insurance (medical vision, life, dental)
EMPLOYEE BENEFITS TOTAL
SALARY & BENEFITS GRAND TOTAL
OASDI
U.I.
PAYROLL TAX TOTAL
REVISED EXHIBIT B-1
Children/Youth Assertive Community Treatment
Uplift Family Services
July 1, 2018 - December 31, 2018 (Six Months)
Program Support Staff
SALARY TOTAL
PAYROLL TAXES:
Family Specialist
Education/Vocational Specialist
Addiction Counselor II
Budget Categories -
Annual Salary
Total Proposed Budget
Line Item Description (Must be itemized)
PERSONNEL SALARIES:
Mental Health Clinician II
Mental Health Clinician I
Addiction Counselor III
Clinical Program Manager
Client Services Coordinator
FACILITY/EQUIPMENT TOTAL
OPERATING EXPENSES:
Telephone
Answering Service
Postage
Printing/Reproduction
Rent/Lease Building
Rent/Lease Equipment
Utilities
Repairs and Maintenance
Staff Mileage/vehicle maintenance
Staff Training/Registration/Recruitment
Depreciation
OPERATING EXPENSES TOTAL
Publications
Legal Notices/Advertising
General Office Expenditures
Food
Program Supplies - Therapeutic
Program Supplies - Medical
1080 -$
1081 1,234$
1082 8,752$
1083 182,235$
192,220$
1090 -$
1091 -$
1092 37,005$
37,005$
1190 -$
1191 -$
-$
2000 -$
2001 11,148$
11,148$
Vol/Units of Rate $ Amt.
3000 45,390 2.02$ 91,688$
3100 309,151 2.61 806,883
3200 - 3.88 -
3300 3,804 4.82 18,335
358,345 916,906$
Estimated % of Federal Financial Participation 50%458,453$
80%
MEDI-CAL REVENUE TOTAL 728,940$
4000 -$
4100 -$
4200 -$
4300 -$
-$
5000 485,960$
5100 CSS Non-Recurring Funds -$
485,960$
NON-MEDI-CAL CLIENT SUPPORTS
FINANCIAL SERVICES EXPENSES:
Accounting/Bookkeeping
Translation Services
Contract Psychiatrist
SPECIAL EXPENSES TOTAL
FIXED ASSETS:
Computers & Software - Telephone System & Computer Network
Furniture & Fixtures
External Audit
Insurance
Indirect Expenses
FINANCIAL SERVICES TOTAL
SPECIAL EXPENSES (Consultant/Etc.):
Consultant (network & data management)
MENTAL HEALTH REVENUE:
Case Management
Mental Health
Crisis Services
Medication Support
FIXED ASSETS TOTAL
NON MEDI-CAL CLIENT SUPPORT EXPENSE:
Housing Assistance/Lodging
Misc. Client Supports - Flex Funds
NON MEDI-CAL CLIENT SUPPORT EXPENSE TOTAL:
TOTAL
PROGRAM
EXPENSES 1,214,901$
TOTAL
PROGRAM
REVENUE 1,214,901$
Other
Other
OTHER REVENUE TOTAL
MHSA FUNDS:
CSS Recurring Funds
MHSA FUNDS TOTAL
Estimated Medi-Cal Billing Totals
Estimated % of Clients Served that will be Medi-Cal Eligible
OTHER REVENUE:
Client Rents
Other
2000 Client Housing Support Expenditures (Service Function Code 70)$0
2001 Client Flexible Support Expenditures (Service Function Code 72)$11,148
2001.1 $0
2001.4 $0
2001.7 $0
2001.8 $0
2001.9 $0
2001.10 $0
2001.11 $0
2001.12 $0
NON-MEDI-CAL CLIENT SUPPORTS TOTAL $11,148
Child Care
EMQFF anticipates no other Non Medi-Cal Support Expenditures (Service Function Code 78) or any Non Medi-Cal Capital
asset purchases (Service Function Code 75).
Client Transportation and Support
Education and employment supports
Respite Care
Household Item
Medication & Medical Supports
Utility Vouchers
"the cost of housing supports, including housing subsidies for permanent, transitional and
"the cost of providing supports to clients, family members, and caregivers including cash
Item
Clothing/Food/Hygiene
Revised Exhibit C-1
PROGRAM EXPENSES
Personnel Salaries, Payroll Taxes & Employee Benefits - Line Items 0001- 0042
0001 Mental Health Clinician I
5 FTE @ semi-annually salaryof $25,624, total $128,120
0002 Mental Health Clinician II
3 FTE @ semi-annually salaryof $30,763, total $92,289
0003 Family Specialist
4 FTE @ semi-annually salaryof $17,261, total $69,044
0004 Education/Vocational Specialist
3 FTE @ semi-annually salaryof $20,078, total $60,233
0005 Addiction Counselor II
2 FTE @ semi-annually salaryof $18,842, total $37,684
0006 Addiction Counselor III
1 FTE @ semi-annually salaryof $27,769, total$27,769
0007 Clinical Program Manager
2 FTE @ semi-annually salaryof $35,552, total $71,104
0008 Client Service Coordinator
0.5 FTE @ semi-annually salaryof $23,809, total $11,902
0009 Associate Director
0.28 FTE @ semi-annually salaryof $42,984, total $11,821
0010 Program Support Staff
3.49 FTE @ semi-annually salary of $31,458, total $109,788
Children/Youth Assertive Community Treatment
Uplift Family Services
FY 2018-2019 Six Months
BUDGET NARRATIVE - EXPENSES
Revised Exhibit C-1
0030 OASDI
Calculated at 6.2% of salaries. Semi-annually cost is $19,114
0031 FICA/MEDICARE
Calculated at 1.45% of salaries. Semi-annually cost is $4,470
0032 UI
Calculated at 1% of salaries. Semi-annually cost is $3,084
0040 Retirement
Calculated at 3.5% of salaries. Semi-annually cost is $10,828
0041 Workers Compensation
Calculated at 2.35% of salaries. Semi-annually cost is $7,203
0042 Health insurance (medical, vision, life, dental)
Calculated at 24% of salaries. Semi-annually cost is $72,547
($854,240)
Facilities/ Equipment Expenses - Line Items 1010-1013
1010 Rent/Lease Building
1011 Rent/Lease Equipment
0.76 FTE Administrative Assistants,
0.25 FTE Supervisor Admin Operation,
0.25 FTE Regional Director,
0.25 FTE Director Clinical Operations,
0.44 FTE Outcomes - Research Specialist,
0.11 FTE Training – Learning Partner
1.36 FTE Compliance - Health Info Technician.
These positions are shared direct program costs that provide direct clinical, operational support,
quality, compliance and outcomes support and management and supervision support, to produce
required program outcomes to all programs in this region. 25% of cost is allocated to this program
using the basis of direct wages by program for this region’s programs.
This includes building rent or depreciation, storage and file storage unit rental payments and all
the costs associated with storing and retrieving of client, personnel or other files or records. Cost
are allocated between programs on the basis of payroll dollars and have been estimated based on
historical trends and the utilization of the agency’s existing office in Fresno. Estimated cost is
$42,328 per six months.
Revised Exhibit C-1
1013 Building Maintenance
($50,501)
Operating Expenses - Line Items 1060-1077
1070 Staff Mileage/Vehicle Maintenance
Primarily includes mileage reimbursement paid (at the current federal rate $0.545 per mile) to staff
supporting program or program related activities. In addition, a component of travel costs may
include overnight travel by staff for training, meetings or conferences. This also takes into
consideration that we anticipate the majority of program services will be delivered in the
community. Staff Mileage/Vehicle Maintenance is budget at $42,841.
1071 Staff Training/Registration/Recruitment
Includes training in the evidence based practices of Triple P, Trauma Focused CBT, and
Managing and Adapting practices, organizational tools, team/organizational psychology,
philosophy of client based services, integration of roles/team dynamics, assessment and
individualized treatment planning, general services, organizing admissions and individualized
treatment planning associated with the evidence based practices. Also includes other mandatory
trainings such as first aid and CPR. Staff Training/Registration/Recruitment is budget at $1,538.
Cell Phones, Land Lines, DSL; also includes wireless cards for laptop computers enabling EMQFF
to maintain a fully functional mobile work force with ability to deliver services anywhere. Costs are
allocated between programs on the basis of payroll dollars and have been estimated based on
historical trends. Telephone is budget at $18,494.
1066 General Office Expenditures
General Office Expenditures include, but are not limited to, postage, shipping, printing, dues,
subscriptions, publications, licenses, permits, recruitment, security and staff fees Office Supplies &
Equipment are budget at $4,482.
This includes rental payments for equipment including leased copiers, postage machines, phone
systems, laptops or other communication, office or facility equipment. Cost are allocated between
programs on the basis of payroll dollars and have been estimated based on historical trends and
the utilization of the agency’s existing office in Fresno. Estimated cost is $6,380 per six months.
This includes common area maintenance on leased building charges, maintenance/building repair
charges, HVAC maintenance and repair, landscaping, janitorial services, confidential paper
shredding services, in-house or outside equipment repair and labor. Cost are allocated between
programs on the basis of payroll dollars and have been estimated based on historical trends and
the utilization of the agency’s existing office in Fresno. Estimated cost is $1,793 per six months.
1060 Telephone
Revised Exhibit C-1
($69,788)
Financial Services Expenses - Line Items 1080-1085
($192,220)
Special Expenses - Line Items 1090-1092
1092 Contract Psychiatrist
($37,005)
Non-Medi-Cal Client Support Expenses – Line Items 2000-2002.8
2001 Miscellaneous Client Supports – Flex Funds
Professional accounting services, annual audits and information return preparation. Audit is
budget at $1,234.
Depreciation includes depreciation on leasehold improvements, office furniture/fixtures and
equipment meeting amortization thresholds. Depreciation is budget at $2,434.
1081 External Audit
1076 Depreciation
1082 Insurance
Includes general business liability and property coverage along with professional liability
insurance. Costs are allocated between programs on the basis of direct labor dollars and
estimated based on historical trends. Insurance is budget at $8,752.
1083 Indirect Expenses
Represents the indirect costs of the agency's general and administrative shared support services
such as finance, accounting, billing, human resources, clinical administration, information
technology, professional fees, HIPPA compliance and clinical record audits, risk management and
program fidelity, recruiting and human resources support, MIS infrastructure & QI/UM department
support and oversight as well as executive management. Costs that cannot be specifically
charged to a program are allocated to programs on the basis of direct labor program costs prior to
the addition of taxes and benefits. Indirect costs have been budgeted at 15% of total program
expenses. Indirect expenses are budget at $182,235.
This is a contract position estimated to cost $195 per hour. The psychiatrist will be required
approx. 16 hours per month and will provide medical oversight/supervision of program services.
Contract Psychiatrist is budget at $37,005.
Revised Exhibit C-1
($11,148)
“Whatever it takes” flexible funding for client needs to maintain growth, functioning and recovery
and to provide for the purchase of a variety of goods and services directly related to the client’s
service plan, or of an emergency nature and not available through the community or any other
funding source. Misc. Client Supports – Flex Funds are budget at $11,148.
TOTAL PROGRAM EXPENSE:($1,214,901)