HomeMy WebLinkAboutAgreement A-19-438 with DHCS.pdfCommunity Mental Health Block Grant
Application (MHBG)
FY 2019-20
Presented to:
State of California
Department of Health Care Services
Dawan Utecht, Director
Department of Behavioral Health
August 5, 2019
Agreement No. 19-438
Page 2 of 21
Table of Contents
1.Signed Initial Allocation Worksheet, DHCS 1750 (Enclosure 1)3
2.Signed Agreements (Enclosure 4)4
3.Signed Certifications (Enclosure 5)8
4.Completed MHBG Per Program Data Sheet, DHCS 1751 (Enclosure 6)10
5.Federal Grant Detailed Per Program Budget, DHCS 1779 (Enclosure 7)11
6.Program Narrative, Transitional Residential Board and Care Services
Appendix A
12
21
Page 4 of 21
Enclosure 4
FY 2019-20 MHBG Renewal Application Page 1 of 4
COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT FUNDING
AGREEMENTS
Public Law 106-310 (Children’s Health Act of 2000)
Public Law 102-321; Title II-Block Grants to States Regarding
Mental Health & Substance Abuse
Part B of Title XIX of the Public Health Service Act [42 U.S.C. 300x-1 et seq.]
The county, as recipient of grant funds, acknowledges and agrees that the county and
its subcontractors shall provide services in accordance with all applicable federal and
State statutes and regulations including the following:
Section 1911
Subject to Section 1916, the State/County involved will expend the grant only for the
purpose of:
(1) Carrying out the plan submitted under Section 1912(a) [State Plan for
Comprehensive Community Mental Health Services] by the State for the fiscal year
involved;
(2) Evaluating programs and services carried out under the plan; and
(3) Planning, administration, and educational activities related to providing services
under the plan.
Section 1912
(c)(1) & (2) [As a funding agreement for a grant under Section 1911 of this title the
Secretary establishes and disseminates definitions for the terms “adult with a serious
mental illness” and “children with a serious emotional disturbance” and the State/County
will utilize such methods [standardized methods, established by the Secretary] in making
estimates [of the incidence and prevalence in the County of serious mental illness among
adults and serious emotional disturbance among children].
Section 1913
(a)(1)(C) the County will expend for such system [of integrated services described in
Section 1912(b)(3)] not less than an amount equal to the amount expended by the
County for fiscal year 1994.
[A system of integrated social services, educational services, juvenile services, and
substance abuse services that, together with health and mental health services, will be
provided in order for such children to receive care appropriate for their multiple needs
(which includes services provided under the Individuals with Disabilities Education
Act)].
(b)(1) The County will provide services under the plan only through appropriate
qualified community programs (which may include community mental health centers,
child mental health programs, psychosocial rehabilitation programs, mental
Page 5 of 21
Enclosure 4
FY 2019-20 MHBG Renewal Application Page 2 of 4
health peer-support programs, and mental health primary consumer-directed
programs).
(b)(2) The State agrees that services under the plan will be provided through
community mental health centers only if the centers meet the criteria specified in
subsection (c).
(c)(1) With respect to mental health services, the centers provide services as follows:
(A) Services principally to individuals residing in a defined geographic
area (hereafter in the subsection referred to as a “service area”).
(B) Outpatient services, including specialized outpatient services for
children, the elderly, individuals with a serious mental illness, and
residents of the service areas of the centers who have been
discharged from inpatient treatment at a mental health facility.
(C) 24-hour-a-day emergency care services.
(D) Day treatment or other partial hospitalization services, or
psychosocial rehabilitation services.
(E) Screening for patients being considered for admission to state mental
health facilities to determine the appropriateness of such admission.
(2) The mental health services of the centers are provided, within the limits of the
capacities of the centers, to any individual residing or employed within the
service area of the center regardless of ability to pay for such services.
(3) The mental health services of the centers are available and accessible promptly,
as appropriate and in a manner which preserves human dignity and assures
continuity and high quality care.
Section 1916
(a) The County involved will not expend the grant--
(1) to provide inpatient services;
(2) to make cash payments to intended recipients of health services;
(3) to purchase or improve land, purchase, construct, or permanently improve
(other than minor remodeling) any building or other facility, or purchase
major medical equipment;
(4) to satisfy any requirement for the expenditure of non-federal funds as a
condition for the receipt of federal funds; or
(5) to provide financial assistance to any entity other than a public or nonprofit
private entity.
Page 6 of 21
Enclosure 4
FY 2019-20 MHBG Renewal Application Page 3 of 4
(b) The County involved will not expend more than ten percent of the grant for
administrative expenses with respect to the grant.
Section 1946 PROHIBITIONS REGARDING RECEIPT OF FUNDS
(a) Establishment -
(1) Certain false statements and representation - A person shall not knowingly
and willfully make or cause to be made any false statement or representation
of a material fact in connection with the furnishing of items or services for
which payments may be made by a State from a grant made to the State
under Section 1911 or 1921.
(2) Concealing or failing to disclose certain events - A person with knowledge
of the occurrence of any event affecting the initial or continued right of the
person to receive any payments from a grant made to a State under Section
1911 or 1921 shall not conceal or fail to disclose any such event with an
intent fraudulently to secure such payment either in a greater amount than is
due or when no such amount is due.
(b) Criminal Penalty for Violation of Prohibition - Any person who violates any
prohibition established in subsection (a) shall for each violation be fined in
accordance with Title 18, United States Code, or imprisoned for not more than
five years, or both.
Section 1947 NONDISCRIMINATION
(a) In General -
(1) Rule of construction regarding certain civil rights laws - For the purpose of
applying the prohibitions against discrimination on the basis of age under
the Age Discrimination Act of 1975, on the basis of handicap under Section
504 of the Rehabilitation Act of 1973, on the basis of sex under Title IX of
the Education Amendments of 1972, or on the basis of race, color, or
national origin under Title VI of the Civil Rights Act of 1964, programs and
activities funded in whole or in part with funds made available under
Section 1911 or 1921 shall be considered to be programs and activities
receiving federal financial assistance.
(2) Prohibition - No person shall on the grounds of sex (including, in the case of
a woman, on the grounds that the woman is pregnant), or on the grounds of
religion, be excluded from participation in, be denied the benefits of, or be
subjected to discrimination under, any program or activity funded in whole
or in part with funds made available under Section 1911 or 1921.
Page 8 of 21
Enclosure 5
FY 2019-20 MHBG Renewal Application Page 1 of 2
CERTIFICATIONS
CERTIFICATION REGARDING LOBBYING
1)No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person influencing or attempting to influence an officer or employee
of any agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with the awarding of any federal
contract, the making of any federal grant, the making of any federal loan, the entering
into of any cooperative agreement, and the extension, continuation, renewal, amendment,
or modification of any federal contract, grant, loan, or cooperative agreement.
2)If any funds other than federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency,
a member of Congress, an officer or employee of Congress, or an employee of a Member
of Congress in connection with this federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure
Form to Report Lobbying,” in accordance with its instructions.
3)The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subcontracts, subgrants, and
contracts under grants, loans, and cooperative agreements) and that all subrecipients shall
certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. Submission of this certification is prerequisite for
making or entering into this transaction imposed by Section 1352, Title 31, and U.S. Code.
Any person who fails to file the required certification shall be subject to a civil penalty of
not less than $10,000 and not more than $100,000 for each such failure.
SALARY CAP
The undersigned certifies that no grant funds will be used to pay an individual salary at a rate
in excess of $192,300 per year, not including benefits.
DRUG FREE WORK ENVIRONMENT
The undersigned certifies that reasonable efforts are made to maintain a drug-free work
place in all programs supported by the Federal Block Grant funds.
Page 10 of 21
State of California —Health and Human Services Agency Department of Health Care Services
Enclosure 6
2019-2020
MHBG PROGRAM DATA SHEET
Complete one sheet for each MHBG funded program that supports transformation activities (as budgeted).
COUNTY: __Fresno__________________________________________________________________
PROGRAM TITLE: __Transitional Residential Board and Care Services_________________________
PROGRAM CONTACT/TITLE: __Rita R. Mehia, LMFT, Clinical Supervisor__ ____________________
Phone #: _(559) 600-6688___ FAX: _____________ E-Mail: __mehia@fresnocountyca.gov_____
MHBG FUNDING LEVEL: (Grant Detailed Program Budget, DHCS 1779, Line 38, Net Cost) $_2,524,182.00__
TARGET POPULATION(S): (ESTIMATED NUMBER OF CONSUMERS TO BE SERVED IN THE YEAR WITH MHBG FUNDS)
SMI ADULT (18-59) 128 SMI OLDER ADULT (60+) 37 SED CHILD (0-17) _________
TYPES OF TRANSFORMATIONAL SERVICE(S) PROVIDED
•Check all categories that are applicable
•Please elaborate in the narrative portion of the application
Transformational Categories
Is MHBG funding used
to support this goal?
If yes, Please check
(√)
Americans Understand that Mental Health is Essential to Overall Health √
Mental Health Care is Consumer and Family Driven √
Disparities in Mental Health Services are Eliminated √
Early Mental Health Screening, Assessment, and Referral to Services are Common Practice √
Excellent Mental Health Care is Delivered and Research is Accelerated √
Technology is Used to Access Mental Health Care and Information √
ADDITIONAL COMMENTS:
DHCS 1751 (05/19)
Page 11 of 21
State of California -Health and Human Services Agency Department of Health Care Services
Enclosure 7
Page 1
FEDERAL GRANT DETAILED PROGRAM BUDGET STATE FISCAL YEAR: 2019 – 2020
TYPE OF GRANT: MHBG
COUNTY: FRESNO SUBMISSION DATE: Revised April 15, 2019
FISCAL CONTACT: Laurentius Harlan Theng PROGRAM CONTACT: Rita R. Mehia, LMFT
TELEPHONE NUMBER: (559) 600-4619 TELEPHONE NUMBER: (559) 600-6688
EMAIL ADDRESS: lharlantheng@fresnocountyca.gov E-MAIL ADDRESS: mehia@fresnocountyca.gov
PROGRAM NAME: Transitional Residential Board and Care Svcs
STAFFING 1 2 3
ANNUAL GRANT LAST APPROVED REQUEST OR
TITLE OF POSITION SALARY FTE BUDGET CHANGE TOTAL
1 $ -
2 $ -
3 $ -
4 $ -
10 $ -
11 $ -
12 TOTAL STAFF EXPENSES (sum lines 1 thru 11) $ - $ - $ - $ -
13 Consultant / Contract Costs (Itemize): $ -
14 Contractors under County Agreement No. 17-377 (DDX) $ 2,271,764 $ 2,271,764
15 Summary: TRSP/STRSP services are provided through all-inclusive daily $ -
16 rates as set by individual Contractors in Appendix A. $ -
17 Equipment (Where feasible lease or rent) (Itemize): $ -
18 $ -
19 $ -
20 $ -
22 Supplies (Itemize): $ -
23 $ -
27 $ -
28 Travel -Per diem, Mileage, & Vehicle Rental/Lease $ -
29 $ -
30 Other Expenses (Itemize): $ -
31 $ -
31 $ -
37 COUNTY ADMINISTRATIVE COSTS (10% MHBG) $ 252,418 $ 252,418
38 NET PROGRAM EXPENSES (sum lines 12 thru 37) $ - $ 2,524,182 $ 2,524,182
39 OTHER FUNDING SOURCES: Federal Funds
40 Non-Federal Funds $ 2,475,818 $ 2,475,818
41 TOTAL OTHER FUNDING SOURCES (sum lines 39 & 40) $ - $ 2,475,818 $ 2,475,818
42 GROSS COST OF PROGRAM (sum lines 38 and 41) $ -$ 5,000,000 $ 5,000,000
DHCS APPROVAL BY:
TELEPHONE:
DHCS 1779 (05/19) DATE:
Transitional Residential Board and Care Services Program Narrative - Page 1 of 10
PROGRAM NARRATIVE
Fresno County Department of Behavioral Health
Transitional Residential Board and Care Services
By Contractors
A.STATEMENT OF PURPOSE
Pursuant to Welfare and Institutions Code Section 5801 and the California Code of
Regulations Title 22, Fresno County Department of Behavioral Health (DBH) provides
placements for adults with serious mental illness (SMI) in secured, certified or licensed
facilities with the appropriate level of care and services. Historically, SMI adults have been
classified as difficult to place, resulting in many individuals being placed at higher levels of
care such as State Hospitals, Institutions of Mental Disease (IMD), Mental Health
Rehabilitation Centers (MHRC) or Skilled Nursing Facilities (SNF). A majority of the higher
level of care facilities are located outside of the County. The transition from locked and/or
higher-level of care institutions to less restrictive facilities, as determined by DBH clinical
staff, through transitional residential board and care services allows for integrative
approaches in collaboration with local medical health, substance use disorder service
providers, spiritual organizations, educational institutions, cultural brokers, and other mental
health partners to provide an integrated care experience. Placement at appropriate service
levels and closer collaboration of DBH with facility staff ensures individuals are progressing
in treatment with an ultimate goal of stepping into lower levels of care and restoring their
ability to take care of their basic needs on their own, with increased stabilization of mental
health symptoms, in order to live with increased independence.
Licensed residential care facilities that provide a transitional residential services program
(TRSP) or a specialized transitional residential services program (STRSP) are the lowest
level of care within the transitional board and care services. TRSP provides supplemental
board and care services, which are above the standard board and care service level, by
licensed providers with a less restrictive level of care to SMI adults through structured,
therapeutic support in a residential setting. The range of services focus on the individual’s
wellness and recovery, working to facilitate returning or continuing to live in the community,
and including medication management/education and self-care. STRSP additionally
possesses care exemptions from Community Care Licensing (CCL), which allows them to
provide services to individuals with mental health disorders and a wide variety of specialized
medical and behavioral needs.
B.MEASURABLE OUTCOME OBJECTIVES
The program’s goal is to increase stability and wellness in the community using natural
supports to increase overall and independent wellness, while reducing recidivism back to
Lanterman Petris Short (LPS) conservatorship and/or placement in locked treatment
facilities.
Page 12 of 21
Transitional Residential Board and Care Services Program Narrative - Page 2 of 10
FY 2019-20 Objectives:
1. Place 165 adults locally at TRSP and STRSP facilities, allowing these individuals to
remain closer to families while they receive services.
2. Reduce hospitalizations and inpatient crisis stabilization services.
3.Maintain an information system to track the number of co-occurring adults served at the
program level. Data continues to be underreported due to stigma.
FY 2018-19 Outcomes:
The following data was tracked in the County’s conservatorship database and the electronic
health record system, Avatar.
1.There were 682 total placements at licensed residential care facilities, of which 549
(80%) were placed within Fresno County. 260 (37.1%) placements were at TRSPs and
STRSPs, with 245 (94.2%) placed within Fresno County.
2.157 unique adults were placed at TRSP and STRSP facilities, with an average length of
stay of 240 days. This is a 5.4% increase from unique adults (149) and a 6.3%
decrease in average length of stay (256 days) in FY 2017-18.
3.20% of persons served by the DBH Adult System of Care (ASOC) programs were
hospitalized once; 25% received inpatient crisis stabilization services. Of the adults
placed at TRSPs and STRSPs, 24.2% were hospitalized at least once after placement
and 26.1% received inpatient psychiatric or crisis stabilization center services.
4.Of 4,089 adults who completed the core assessment tool in the County’s Avatar, 76%
indicated “yes” to there being past and present substance use (tobacco, alcohol,
caffeine, complementary alternative medicine, over-the-counter drugs and illicit drugs).
One percent responded “possibly”, while 21% and 2% recorded “no” and “unknown”
respectively. 81% of adults placed at TRSPs and STRPs with an Avatar core
assessment tool had past and present substance use; 13% had no substance use, and
6% had an unknown substance use status.
C.PROGRAM DESCRIPTION
Placement to TRSP and STRSP services must be authorized by the DBH Recovery with
Inspiration, Support and Empowerment (RISE) Conservatorship Team. Services may range
from basic services, which include reasonable access to required medical treatment, up-to-
date psychopharmacology and transportation to needed off-site services, and
bilingual/bicultural programming as appropriate for individuals who have a chronic
psychiatric impairment and whose adaptive functioning is moderately impaired, to enhanced
services, which are designed to service individuals who have subacute psychiatric
Page 13 of 21
Transitional Residential Board and Care Services Program Narrative - Page 3 of 10
impairment and/or whose adaptive functioning is severely impaired. Services may also
include intensive support and rehabilitation to individuals as an alternative to State
hospitalization or placement in other 24-hour care facilities, and are aimed at helping
individuals to develop skills to become self-sufficient and increase their levels of
independent functioning.
Each TRSP and STRSP facility has a written Program Design (Title 22, Plan of Operation)
approved by DBH, which contains a statement of purpose, a statement of goals, a
description of program methods and a staff training plan. The activities and opportunities
provided to each individual are consistent with the written Program Design. The facility
administrator, individual and agency referral person/authorized representatives are involved
in the development of the individual's "Appraisal/Needs and Services Plan". Staff
communicate and participate with other agencies in case conferences and in the
development of a plan of care or educational plan to ensure continuity in each individual's
planned activities. The supervision and training provided to each individual follows the
objectives and plans written in the "Appraisal/Needs and Services Plan". The facility
provides supervision and training seven days per week with a staff ratio adequate to
implement the "Appraisal/Needs and Services Plan".
A written monthly Activity Schedule is posted for all hours that individuals are awake and
under the supervision of the facility, seven days per week. The Activity Schedule reflects
the time and place of usual individual activities, with at least one recreational activity each
day and at least one activity in the community each week. The facility teaches and enables
individuals to practice skills and behaviors that are necessary for attaining greater
independence in the home and in the community in accordance with the “Appraisal/Needs
and Services Plan". Use of leisure time in a constructive manner is encouraged. Daily
activities are age appropriate and natural environments and materials are used in teaching
skills to individuals. Training techniques are also individualized in accordance with the
"Appraisal/Needs and Services Plan” and are consistent with the principles of least
restrictive method. All staff persons responsible for carrying out an individual's
"Training/Treatment" are familiar with its objectives and methods of implementation. There
is a continuity, through staff changes, in training provided to individuals, as evidenced by
either oral or written communications between staff on different shifts.
Every twelve months the "Appraisal/Needs and Services Plan" is reviewed by the case
manager/authorized representative, individual and facility staff to measure and document
progress of set objectives and/or the need to modify. Every six months the individual is
assessed by the case manager with input from facility staff. When the "Appraisal/Needs and
Services Plan" needs to be updated, facility staff bring this to the attention of the case
manager. The facility staff, case manager and individual participate in the revision, as
appropriate.
Page 14 of 21
Transitional Residential Board and Care Services Program Narrative - Page 4 of 10
COMMUNITY INTEGRATION
If the facility is located in a residential neighborhood, it must be physically compatible with
residences in that neighborhood. Individuals have access to resources available to other
members of the local community, and are given regular opportunities to use those resources
and to practice community and independent living skills in their local community. The facility
provides group activities which include activities involving six or fewer individuals. At least
one recreational activity a week will be offered in the community appropriate to the interests
or development of interests of the individuals.
SOCIAL - PSYCHOLOGICAL ENVIRONMENT
The physical aspects of the facility must be appropriate to the age and physical abilities of
the individuals. Individuals eat in the dining room or eating areas typically used by family
and/or staff members. Each individual wear/have properly fitting clothing. Each individual
shall receive training, or be assisted, in selecting clothing which is appropriate to his or her
age, sex and the season. Each individual wears his or her own clothing.
Communication and interaction between staff and individuals reflect respect and caring.
Staff makes an effort to establish positive relationships with individuals via communication
methods which are appropriate for those individuals. Staff makes an effort to establish
positive relationships with individuals' family members. Individuals share in facility decision-
making through weekly house meetings designed to encourage participation. There is
recognition and acceptance by staff of individuals' cultural and ethnic differences.
Individuals are encouraged to pursue individual interests and schedules.
The facility is furnished, decorated, and arranged to provide a home-like, non-institutional
atmosphere. Bathroom facilities are designed and equipped to afford privacy. No more
than two individuals shall share a bedroom. Bedrooms are not used as passageways to
other rooms. Individuals are allowed to use bedrooms as places to be alone. Individuals
have access to all common areas of the residence, except controlled storage areas and staff
designated areas.
TRSP and STRSP services may consist of, but are not limited to, all of the components
listed above. They are to be provided to each individual as specified in the individual's
"Appraisal/Needs and Services Plan," or as the need arises. Contractors of TRSP and
STRSP services are paid at an all-inclusive daily rate for services. In the event individuals
also fall under more than one enhanced STRSP category as set forth below, County shall
pay only one all-inclusive rate, which is to be mutually agreed upon by County and
Contractor. Possession of care exemptions approved by CCL will be required to provide
services to individuals with specialized medical needs. Appendix A provides a full list of
existing Contractors and the daily rates for their services and target populations.
Page 15 of 21
Transitional Residential Board and Care Services Program Narrative - Page 5 of 10
STRSP INDIVIDUAL CATEGORIES
CHRONIC INEBRIATES: Dual diagnosis individuals needing controlled community access.
Services provided will include:
•15 minute visuals, 24/7, 365 days.
•In-house psychiatrist with assessments done on site.
•On call 24/7 psychiatrist with standing orders for PRN & injectables.
•Prevocational job training on site with a community re-entry based philosophy.
•On-site Drug & Alcohol counselors.
•Day Treatment, Recovery models, and WRAP & Wellness.
•On-site dietician to provide healthy diets.
SPECIAL NEEDS:
•Diabetic – trained staff (incl. LVN, dietary) available to meet CCL Title 22 Section
80092.8. Services provided will include:
i.Insulin shots.
ii.Diabetes maintenance including, but not limited to insulin injections and blood
sugar monitoring.
iii.On-site dietician to provide special diet (sugar free menu).
iv.Blood sugar monitoring by licensed, qualified staff.
v.50% of staff shall be certified Medical Assistants.
vi.15 minute visuals, 24/7, 365 days a year.
vii.On call 24/7 psychiatrist with standing orders for PRN & injectables.
viii.Prevocational job training on site with a community re-entry based
philosophy.
ix.Day Treatment, Recovery models, and WRAP & Wellness.
•Conditions of Life – facility upgrades & trained staff available to meet CCL Title 22
Section 80077.2-3, 80001d.(2) for individuals who rely on others to assist with most
activities of daily living (ADLs), individuals with lack of hazard awareness/impulse
control or individuals with medical conditions for which they need
assistance/observation. Services provided will include:
i.15 minute visuals 24/7, 365 days a year.
ii.On-site dietician to provide special diets, as required.
iii.50% staff are certified Medical Assistants to monitor health conditions.
iv.On call 24/7 Psychiatrist with standing orders for PRN & injectables.
v.Prevocational job training on-site with a community re-entry based
philosophy;
vi.Day Treatment, Recovery models, and WRAP & Wellness.
vii.CCL waiver for individuals needing oxygen.
•Non-Ambulatory: all the above facility services shall be available to non-ambulatory
individuals. In addition to diabetic, dual-diagnosis and other conditions of life
services, the facility shall provide:
i.Trained staff available to assist non-ambulatory individuals with ADL’s.
Facility-wide training shall be rendered to ensure the safety of non-
Page 16 of 21
Transitional Residential Board and Care Services Program Narrative - Page 6 of 10
ambulatory individuals with regards to egress, mobility and emergency
procedures.
ii.Transportation to allow non-ambulatory individuals to participate in
community outings.
•Ambulatory Issues - trained staff (incl. LVN, dietary) available to meet CCL Title 22
Section 80010.
i.Amputee.
ii.Wheelchair dependent (for mobility).
iii.Walkers/Other Walking Assistance Devices.
iv.Visual Impairment/Including Legal Blindness.
•Medical – trained staff to provide care for individuals who have any of the following
restricted health conditions, or who require any of the following health services:
i.Colostomy bags – as specified in CCL Title 22, Section 87621.
ii.Oxygen dependent individuals - as specified in CCL Title 22, Section 87618.
iii.Catheter services - as specified in CCL Title 22, Section 87623.
STRSP Contractors have trained staff available to provide care within a facility intended for
individuals with mental health disorders, specific characteristics, and a history of additional
behaviors/legal status including, but not limited to the following behavioral/legal status:
•LPS Conservatorship - Individuals moving from locked and out of county (possible)
IMD or acute inpatient psychiatric facilities.
•Aggressive Behaviors - Recent physical aggressive episode toward a person
(general) or history of physical assault on a staff.
•Fire Setting
•Elopement - Elopement is considered not returning by curfew.
•Sexual Assault or Sex Offender Status
•Young Adults - Young adults considered to be between the ages of 18-24 years old.
•Individuals with Mild Developmental Delays - “Mild developmental delay” defined as
borderline intellectual functioning with an IQ of just below 80.
D.CULTURAL COMPETENCY
The Department of Behavioral Health works to support cultural traditions and social
practices for each person served and acknowledges the impact that this may have on each
person’s ability to socially regulate and express themselves with their mental health. Each
person’s treatment is guided by the culture the person identifies with. Staff research,
consult and collaborate with various partners, including cultural brokers, to support this
value and as a resource in the recovery process. DBH clinicians embrace the idea that
culture and mind are inseparable, and are trained to provide psychosocial assessments
from a developmental, social and cognitive perspective that include cultural differences that
may go beyond traditional theoretical approaches.
TRSP and STRSP program staff recognize and accept individuals’ cultural and ethnic
differences. Staff encourage observations of culturally appropriate holidays, events, and
Page 17 of 21
Transitional Residential Board and Care Services Program Narrative - Page 7 of 10
traditions, in accordance with the ethnic backgrounds of individuals and individuals’ wishes.
This may include, but not be limited to, offering activities, foods, and decorations appropriate
to the individual.
E.TARGET POPULATION
The target population are adults diagnosed with SMI , who are returning from out of county
locked 24-hour supervised IMD/MHRC facilities to less restricted and supervised
environment, LPS Conserved adults, or adults recently released but identified as high-risk
for receding to LPS Conservatorship. A LPS Conserved adult is identified as unable to
provide a plan for self-care including meals, clothing, and shelter due to their behavioral
health symptoms. The population includes individuals with a dual diagnosis.
F.STAFFING
MHBG will not directly fund program staffing. Contractors are paid at their all-inclusive daily
rate and are expected to staff accordingly to their Program Design. Fresno County is not
requesting new positions to be funded through the MHBG at this time due to the uncertainty
of MHBG funding on a continuing basis for this program and the sustainability of hiring new
staff by DBH.
G.DESIGNATED PEER REVIEW REPRESENTATIVE
The designated peer review representative is the Director, Fresno County Department of
Behavioral Health.
H.IMPLEMENTATION PLAN
The program is fully implemented. TRSP and STRSP services have been provided by
Contractors since 2008. Current Fresno County Agreement No. 17-377 was approved in
July 2017 as a master agreement with Ruby’s Valley Care Home, Chimes Home, and
Garden Manor as Contractors. Backer Senior Carehome, BK House of Grace and Joy,
Daily’s Haven, Fillmore Christian Gardens, Haskins Residential Care, Modesto Residential
Living Center, Lakewood Haven, Tender Hands Residential Care and Ratanakone Home
have since been added. Contractors may modify their daily service rate with approval of the
DBH Director, as long as the modification does not result in changes to the contract
maximum compensation.
I.PROGRAM EVALUATION PLAN
Each facility must meet quality assurance standards for licensed residential care facilities.
Facilities eligible to be certified for payment for TRSP services and STRSP services from
Fresno County DBH shall be a licensed Adult Residential Care Facility or licensed
Residential Care Facility for the Elderly, authorized by the California Department of Social
Services (CDSS), Community Care Licensing (CCL) Division, to provide care and
Page 18 of 21
Transitional Residential Board and Care Services Program Narrative - Page 8 of 10
supervision to SMI adults. The facility administrator shall complete 20 hours per year of the
continuing education or in-service training in mental health issues or related topics, in
accordance with the education or training specifications of the CDSS CCL Division. Direct
care staff, employed by the facility, participates in the training activities specified in the
"Fresno County Department of Behavioral Health, Quality Assurance Standards for
Licensed Adult Residential Care Facilities, and Residential Care Facilities: Section 9".
Contractors provide information for monthly billing and other data, as required by the
County's management information system, and a monthly statement of all individuals living
in the facility.
Furthermore, facilities shall be certified for participation by the County and services shall be
provided through written agreement, including but not limited to:
1.Cooperate with County staff, subsequent to referral and with authorization by the
County, in completing the "Appraisal/Needs and Services Plan," as indicated by the
CDSS, Adult Residential Facilities, Division 6, Chapter 1, Section 80068.2, to meet the
goals, objectives, and activities appropriate to the individual. This plan shall be
completed and placed in the individual's record on or before the first day of placement
and kept current.
2.Complete a "Facility Service Plan" indicating the specific services to be provided to
address the needs identified in the "Appraisal/Needs and Services Plan". This plan shall
be completed and placed in the individual's record on or before the first day of
placement.
3.Maintain individual records, on the premises, in accordance with "Fresno County
Department of Behavioral Health, Quality Assurance Standards for Licensed Adult
Residential Care Facilities and Residential Care Facilities, Section 8 - Individual
Records" to promote the services to each individual. These records shall include:
a.The "Appraisal/Needs and Services Plan" specifying the needs to be addressed.
b.Weekly notes shall:
i.Address all needs, objectives, and services provided by facility staff to
implement the "Facility Service Plan" for each individual.
ii.Address significant occurrences affecting the individual (incidents, illness.
exacerbation of symptoms, signs of improved functioning, etc.), as appropriate.
iii.Describe behavioral observations and symptoms.
iv.Be written by staff having direct supervision/observation of the individual.
c.Monthly summary notes shall reflect all needs and services addressed in the
"Appraisal/Needs and Services Plan." (Refer to "Fresno County Department of
Behavioral Health, Quality Assurance Standards for Licensed Adult Residential Care
Facilities and Residential Care Facilities: Section 8 - Individual Records".)
d.All other documents/information as required by CDSS CCL Division.
Page 19 of 21
Transitional Residential Board and Care Services Program Narrative - Page 9 of 10
4.Allow access to the facility, to the extent authorized by law, by County and State staff for
assessment of individual(s), monitoring of the contract, record review, consultation with
staff, and evaluation of the facility and services.
5.Maintain the capability to provide the services required to meet the specialized needs of
individuals, as identified in individuals' "Appraisal/Needs and Services Plans".
6.Cooperate and consult with County staff to improve/enhance/modify program services to
meet the need of individuals as indicated in their "Appraisal/Needs and Services Plans."
7.Inform DBH Case Manager and TRSP/STRSP Services Coordinator immediately and
provide a written report within 24 hours of all incidents necessitating an incident report to
CDSS CCL Division. Incidents to be reported include, but are not limited to, death,
accident/injury, abuse, and absence without leave (AWOL).
8.Inform the Coordinator within 24 hours of all individual movements (i.e. admissions to a
general hospital, acute psychiatric facility, and/or AWOL).
9. Encourage individuals to take increased responsibility for own treatment by setting self-
established goals.
10.Provide scheduled and posted activities to encourage the development of activities
satisfying to individuals, as specified in their "Appraisal/Needs and Services Plans". The
posted monthly schedules shall reflect the interests of individuals, expose individuals to
and develop a variety of leisure interests, and develop interpersonal skills and
relationships.
Contractors are encouraged to engage in all quality improvement activities to provide a
welcoming environment, and to continue developing co-occurring substance use and mental
health treatment capability for individuals served and their families.
J.OLMSTEAD MANDATE AND THE MHBG
Fresno County DBH looks towards all funding sources, including MHBG, and the full
spectrum of services to create a complete continuum of care for individuals served, through
integration of all available services. In particular, adults with SMI are transitioned from
locked and/or higher-level of care institutions to less restrictive facilities as determined by
County clinical staff. These facilities are transitional board and care, specialized level of
care services, and/or other certified/licensed facilities with a residential setting in the
community. The range of services provides for the individual’s recovery while working to
facilitate returning to live in the community. Services include on-the-job skills training. DBH
is dedicated to provide treatment at appropriate levels of care and the least restrictive
environment for all individuals served and their families, to promote their wellness, recovery
and resiliency.
Page 20 of 21
Transitional Residential Board and Care Services Program Narrative - Page 10 of 10
Appendix A – Daily Rates of Contracted TRSP and STRSP Service Providers Reasonable access to required medical treatmentUp-to-date psychopharmacologyBilingual/bicultural programmingTransportation to needed off-site servicesSelf-sufficiency skillsEnhancement of independent living skillsOther: Diabetes careOther: Incontinent careOther: Special Diet - health-relatedOther: One-on-one staffing for emergency medical careOther: Access to psychiatric treatmentOther: Behavioral managementOther: Medical and walking devicesOther: Psychiatric and medical conditionsOther: Hospice careOther: On-site drug and alcohol for dual diagnosedOther: Crisis psychiatric evaluation for possible decompensationOther: Basic care and tray service for minor temporary illnesses or recovery from surgeryOther: Clean bed and bath linens weekly, or more often as neededOther: Arrange for transportation for medical and dental appointmentsOther: Laundering personal clothing and hygieneOther: One-on-one supervision (per hour rate - $20/hr.)Other: Special services to meet very difficult individuals (2x rate)Other: On-the-job trainingIndividuals dependent on wheelchairs**Individuals dependent on walking devices (walkers or other walking assistance devices)**Individuals with amputated limbs**Individuals with a visual impairments, including legal blindness**Individuals with colostomy bags**Individuals with diabetes (for maintenance, including but not limited to, insulin injections and blood sugar monitoring)**Individuals dependent on oxygen**Individuals requiring assistance with catheters**Individuals chronically inebriated (due to alcohol addiction and/or dependence) Individuals on a LPS Conservatorship moving from locked out of town Institutes of Mental Disease (IMD)Individuals from acute inpatient psychiatric facilitiesIndividuals with a history of aggressive behaviors such as recent physical aggressive episodes toward others, including staffIndividuals with a history of elopements (not returning to the facility by curfew)Individuals with a history of fire settingIndividuals with previous convictions for sexual assault, or identified as sex offendersYoung adults between the ages of 18 – 24 years oldIndividuals with mild development delays, such as borderline intellectual functioning with an IQ of just below 80Other: Individuals requiring CPAP machine Other: Individuals who require psych injections (routine)Other: Mild retardation and developmentally challengedOther: Hospice waiverOther: Individuals who wander during the nightOther: Individuals who have outburstsOther: Individuals needing one-to-one to keep stable in communityOther: Individuals with very difficult special needs$40.00
$75.00
$90.00
$44.00
$55.00
$70.00
$50.00/$75.00** * * *
$108.00
$35.50
$122.16
$148.73
$426.26
FY 19-20
Daily RateCONTRACTORS/FACILITIES
TARGET POPULATIONSERVICES
Amor Amores Alegre (The Chimes Home)
**Possession of care exemptions approved by CCL will be required to provide services to individuals with specialized medical needs
TRSP
STRSP
Dailey's Haven
Providian Residential Care Services (Fillmore
Christian Gardens)
Backer Senior Carehome
BK House of Grace and Joy
Tender Hands Residential Care
Mark A. Gisler (Ruby's Valley Care Home)
Garden Manor
Haskins Residential Care
Modesto Residential Living Center
Lakewood Haven
Ratanakone Home
Page 21 of 21
COUNTY OF FRESNO
Fresno, CA
- 1 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
SUBSTANCE ABUSE AND MENTAL HEALTH
SERVICES ADMINISTRATION (SAMHSA)
COUNTY COMMUNITY MENTAL HEALTH
BLOCK GRANT (MHBG) RENEWAL
APPLICATION FY 2019-20
FOR ACCOUNTING USE ONLY:
Fund/Subclass: 0001/10000
ORG No.: 5630 ($2,524,182)
Account No.: 4380