HomeMy WebLinkAboutAgreement A-16-492 with DHCS.pdfCommunity Mental Health Block Grant
Application (MHBG)
FY 2016-17
Presented to:
State of California
Department of Health Care Services
Dawan Utecht, Director
Department of Behavioral Health
July 2016
Page 2 of 31
Table of Contents
1. Signed Planning Estimate 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)
• Jail Psychiatric Services Program
• Juvenile Justice SED Dual Diagnosis Outpatient Program
10
11
5. Federal Grant Detailed Per Program Budget DHCS 1779 (Enclosure 7)
• Summary
• Jail Psychiatric Services Program
• Juvenile Justice SED Dual Diagnosis Outpatient Program
12
13
14
6. Program Narrative
• Jail Psychiatric Services Program (A-H)
• Juvenile Justice SED Dual Diagnosis Outpatient Program (A-H)
15
23
Page 3 of 31
State of California -Health and Human Services Agency Department of Health Care Services
Enclosure 1
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)
CENTER FOR MENTAL HEALTH SERVICES (CMHS)
BLOCK GRANTS FOR COMMUNITY MENTAL HEALTH SERVICES (MHBG)
SFY 2016-17 PLANNING ESTIMATE WORKSHEET
COUNTY: FRESNO DATE: April25, 2016
DUNS NUMBER: 080055902
PROPOSED ALLOCATION $ 1,873,865
Base Allocation
Dual Diagnosis Set-Aside
$ 1,454,966
$ 418,899
The County Mental Health Department requests continuation of the SAMHSA, CMHS Block
Grants for Community Mental Health Services (MHBG). These funds will be used in accordance with
Public Law 102-321 (42 U.S.C., Sections 300x through 300x-13), and Public Law (PL) 106-310,
and will be used as stated in the enclosed Community Mental Health Services Block Grant Funding
Agreements with Federal Requirements on Use of Allotments, and the Certification Statements.
The estimate is the proposed total expenditure level for SFY 2016-17. The estimate above is subject to
change based on the level of appropriation approved in the State Budget Act of2016.
In addition, this amount is subject to adjustments for a net reimbursable amount to the county. The
adjustments include, but are not limited to , Gramm-Rudmann-Hollings (Federal Deficit Reduction Act)
reductions, prior year audit recoveries , federal legislative mandates applicable to categorical funding ,
augmentations, etc. The net amount reimbursable will be reflected in reimbursable payments as the
specific dollar amounts of adjustments become known for each county.
The county will use this estimate to build the county's SFY 2016-17 budget for the provision of mental
health services for adults with serious mental illness (SMI) and children with serious emotional
disturbance (SED).
~~~
Chairman, County of Fresno, Board of Supervisors
Ernest Buddy Mendes, Chairman, Board of Supervisors
Print Name
DHCS 1750 (04/14)
~-ll-W\ln
Date
ATTEST:
BERNICE E. SEIDEL, Clerk
Board of Supervisors
By ~SAm._ ~J *''?P Deputy
Page 4 of 31
Enclosure 4
FY 2016-17 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 31
Enclosure 4
FY 2016-17 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 31
Enclosure 4
FY 2016-17 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.
FY 2016-17 MHBG Renewal Application
(b) Enforcement -
(1) Referrals to Attorney General after notice: Whenever the Secretary finds
that a state, or an entity that has received a payment pursuant to Section
1911 or 1921, has failed to comply with a provision of law referred to in
subsection (a)(1), with subsection (a)(2), or with and applicable regulation
(including one prescribed to carry out subsection (a)(2), the Secretary shall
notify the Chief Executive Officer of the state and shall request the Chief
Executive Officer to secure compliance. If within a reasonable period of
time, not to exceed 60 days, the Chief Executive Officer fails or refuses to
secure compliance, the Secretary may--
(1)(A) refer the matter to the Attorney General with a recommendation that
an appropriate civil action be instituted;
(1 )(B) exercise the powers and functions provided by the Age
Discrimination Act of 197 5, Section 504 of the Rehabilitation Act
of 1973, Title IX ofthe Education Amendment of 1972, or Title VI
of the Civil Rights Act of 1964 , as may be applicable; or
(1 )(C) take such other actions as may be authorized by law.
(2) Authority of Attorney General -When a matter is referred to the Attorney
General pursuant to paragraph (1)(A), or whenever the Attorney General
has reason to believe that a State or an entity is engaged in a pattern or
practice in violation of a provision of law referred to in subsection (a)(1)
or in violation of subsection (a)(2), the Attorney General may bring a civil
action in any appropriate district court of the United States for such relief
as may be appropriate, including injunctive relief.
[__ £:4.. ¥{~
Chairman, County of e;no, Board of Supervisors
Ernest Buddy Mendes
Printed N arne
ATTEST:
BERNICE E . SEIDEL, Clerk
Board of Supervisors
By S-v so....y &~
Deputy
~-\ \-~D\Lo
Date
Fresno
County
Page 7 of 31
Enclosure 4
Page 4 of 4
Page 8 of 31
Enclosure 5
FY 2016-17 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, 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 $183,300 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 9 of 31
FY 2016-17 MHBG Renewal Application
Enclosure 5
Page 2 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION INELIGIBILITY AND
VOLUNTARY EXCLUSION -LOWER TIER COVERED TRANSACTIONS
1) The prospective lower tier participant certified, by submission of this proposal , that neither it
nor its principals or contracted providers is presently debarred , suspended , proposed for
debarment, declared ineligible , or voluntarily excluded from participation in this transaction
by any Federal department or agency.
2) Where the prospective lower tier participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this
proposal/application.
CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE
Public Law 103-227 , also known as the Pro-Children Act of 1994 (Act), requires that smoking
not be permitted in any portion of any indoor facility owned or leased or contracted for by an
entity and used routinely or regularly for the provision of health , day care, early childhood
development services, education or library services to children under the age of 18 , ifthe
services are funded by Federal programs either directly or through State or local governments , by
Federal grant , contract, loan, or loan guarantee. The law also applies to children 's services that
are provided in indoor facilities that are constructed, operated or maintained with such federal
funds. The law does not apply to children 's services provided in private residences ; portions of
facilities used for inpatient drug or alcohol treatment; service providers whose sole source of
applicable Federal funds is Medicare or Medicaid ; or facilities where WIC coupons are
redeemed. Failure to comply with the pro visions of the law may result in the imposition of a
civil monetary penalty of up to $1 ,000 for each violation and/or the imposition of an
administrative compliance order on the responsible entity.
By signing this certification, the offer or contractor (for acquisitions) or applicant/grantee (for
grants) certifies that the submitting organization will comply with the requirements of the Act
and will not allow smoking within any portion of any indoor facility used for the provision of
services for children as defined by the Act.
The submitting organization agrees that it will require that the language of this certification be
included in any subawards which contain pro visions for children 's services and that all
subrecipients shall certify accordingly.
E~&-~~-
chairman, Count)fOfireSno , Board of Supervisors
Ernest Buddy Mendes
Printed N arne
ATTEST:
BERNICE E . SEIDEL, Cieri<
Board of Supervisors
By Su ~ ~sb p-p
Deputy
Date
Fresno
County
Page 10 of 31
State of California —Health and Human Services Agency Department of Health Care Services
Enclosure 6
2015-16
MHBG PROGRAM DATA SHEET
Complete one sheet for each MHBG funded program that supports transformation activities (as budgeted).
COUNTY: __FRESNO________________________________________________________________
PROGRAM TITLE: __CONTRACT - Jail Psychiatric Services_________________________________
PROGRAM CONTACT/TITLE: __Jennifer Pardo, Staff Analyst III, Department of Public Health_______
Phone #: __(559) 600-6437__ FAX: __(559) 600-7687__ E-Mail: __jpardo@co.fresno.ca.us__
MHBG FUNDING LEVEL: (Grant Detailed Program Budget, DHCS 1779, Line 38, Net Cost) $1,553,865____
TARGET POPULATION(S): (ESTIMATED NUMBER OF CONSUMERS TO BE SERVED IN THE YEAR WITH MHBG FUNDS)
SMI ADULT (18-59) 3000 SMI OLDER ADULT (60+) ________ 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 (02/15)
Page 11 of 31
State of California —Health and Human Services Agency Department of Health Care Services
Enclosure 6
2016-2016
MHBG PROGRAM DATA SHEET
Complete one sheet for each MHBG funded program that supports transformation activities (as budgeted).
COUNTY: __FRESNO________________________________________________________________
PROGRAM TITLE: _CONTRACT - Juvenile Justice SED Dual Diagnosis Outpatient______________
PROGRAM CONTACT/TITLE: __Susan Murdock, Program Director___________________________
Phone #: _(559) 600-4876__ FAX: _(559) 496-3650__ E-Mail: _smurdock@co.fresno.ca.us
MHBG FUNDING LEVEL: (Grant Detailed Program Budget, DHCS 1779, Line 38, Net Cost) $340,000___
TARGET POPULATION(S): (ESTIMATED NUMBER OF CONSUMERS TO BE SERVED IN THE YEAR WITH MHBG FUNDS)
SMI ADULT (18-59) SMI OLDER ADULT (60+) ________ SED CHILD (0-17) 80______
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 (02/15)
Page 12 of 31
State of California -Health and Human Services Agency Department of Health Care Services
Enclosure 7
Page 1 of 3
FEDERAL GRANT DETAILED PROGRAM BUDGET STATE FISCAL YEAR: 2016 – 2017
TYPE OF GRANT: MHBG
COUNTY: FRESNO SUBMISSION DATE: July 1, 2016
FISCAL CONTACT: Chao Xiong PROGRAM CONTACT: Earliana Vang
TELEPHONE NUMBER: (559) 600-6052 TELEPHONE NUMBER: (559) 600-6835
EMAIL ADDRESS: cxiong@co.fresno.ca.us E-MAIL ADDRESS: evang@co.fresno.ca.us
PROGRAM NAME: SUMMARY ALL PROGRAMS
STAFFING 1 2 3
ANNUAL GRANT
LAST
APPROVED REQUEST OR
TITLE OF POSITION SALARY FTE BUDGET CHANGE TOTAL
1 $ -
2 $ -
3 $ -
4 $ -
5 $ -
6 $ -
7 $ -
8 $ -
9 $ -
10 $ -
11 $ -
12 TOTAL STAFF EXPENSES (sum lines 1 thru 11) $ - 0.00 $ - $ - $ -
13 Consultant / Contract Costs (Itemize):
14 Jail Psychiatric Svcs Prog - Contract Corizon Health, Inc. $ 1,533,865 $ 1,533,865
15 JJ SED Dual Diagnosis Prog - Contract Mental Health Systems, Inc. $ 340,000 $ 340,000
16 $
17 Equipment (Where feasible lease or rent) (Itemize):
18 $ -
19 $ -
20 $ -
21 $ -
22 Supplies (Itemize):
23 $ -
24 $ -
25 $ -
26 $ -
27 $ -
28 Travel -Per diem, Mileage, & Vehicle Rental/Lease
29 $ -
30 Other Expenses (Itemize):
31
$ -
32 $ -
33 $ -
34 $ -
35 $ -
36 $ -
37 COUNTY ADMINISTRATIVE COSTS (10% MHBG) $ -
38 NET PROGRAM EXPENSES (sum lines 12 thru 37) $ - $ 1,873,865 $ 1,873,865
39 OTHER FUNDING SOURCES: Federal Funds
40 Non-Federal Funds
41 TOTAL OTHER FUNDING SOURCES (sum lines 39 & 40) $ -
42 GROSS COST OF PROGRAM (sum lines 38 and 41) $ - $ 1,873,865 $ 1,873,865
DHCS APPROVAL BY:
TELEPHONE:
DATE:
DHCS 1779 (06/16)
Page 13 of 31
State of California -Health and Human Services Agency Department of Health Care Services
Enclosure 7
Page 2 of 3
FEDERAL GRANT DETAILED PROGRAM BUDGET STATE FISCAL YEAR: 2016 – 2017
TYPE OF GRANT: MHBG
COUNTY: FRESNO SUBMISSION DATE: July 1, 2016
FISCAL CONTACT: Jennifer Pardo PROGRAM CONTACT: Jennifer Pardo
TELEPHONE NUMBER: (559) 600-6437 TELEPHONE NUMBER: (559) 600-6437
EMAIL ADDRESS: jpardo@co.fresno.ca.us E-MAIL ADDRESS: jpardo@co.fresno.ca.us
PROGRAM NAME: Jail Psychiatric Svcs Prog – Contract Corizon Health, Inc.
STAFFING 1 2 3
ANNUAL GRANT
LAST
APPROVED REQUEST OR
TITLE OF POSITION SALARY FTE BUDGET CHANGE TOTAL
1 Psychiatrist (DDX) $ 185,100 0.82 $ 151,079 $ 151,079
2 Licensed Mental Health Worker Supervisor (DDX) $ 122,720 0.58 $ 71,546 $ 71,546
3 Licensed Mental Health RN (DDX) $ 95,285 1.17 $ 111,103 $ 111,103
4 Licensed Professional Counselor (DDX) $ 113,360 4.84 $ 548,541 $ 548,541
5 Psychiatric Aide/Associate (LPT) $ 60,050 1.63 $ 98,025 $ 98,025
6 Unlicensed Mental Health Specialist I (DDX) $ 60,507 0.58 $ 35,276 $ 35,276
7 Office Assistant III $ 39,686 2.51 $ 99,490 $ 99,490
8 Medical Assistant $ 39,000 1.63 $ 63,664 $ 63,664
9 BENEFITS $ 235,745 $ 235,745 $ 235,745
10 $-
11 $-
12 TOTAL STAFF EXPENSES (sum lines 1 thru 11) $ 951,453 13.76 $- $ 1,414,469 $ 1,414,469
13 Consultant / Contract Costs (Itemize):
14 $-
15 $-
16 $-
17 Equipment (Where feasible lease or rent) (Itemize):
18 $-
19 $-
20 $-
21 $-
22 Supplies (Itemize):
23 $-
24 $-
25 $-
26 $-
27 $-
28 Travel -Per diem, Mileage, & Vehicle Rental/Lease
29 $-
30 Other Expenses (Itemize):
31 $-
32 $-
33 $-
34
35 $-
36 $-
37 COUNTY ADMINISTRATIVE COSTS (10% MHBG) $ 119,396 $ 119,396
38 NET PROGRAM EXPENSES (sum lines 12 thru 37) $- $ 1,533,865 $ 1,533,865
39 OTHER FUNDING SOURCES: Federal Funds
40 Non-Federal Funds
41 TOTAL OTHER FUNDING SOURCES (sum lines 39 & 40) $- $- $-
42 GROSS COST OF PROGRAM (sum lines 38 and 41) $- $ 1,533,865 $ 1,533,865
DHCS APPROVAL BY:
TELEPHONE:
DATE:
DHCS 1779 (06/16)
Page 14 of 31
State of California -Health and Human Services Agency Department of Health Care Services
Enclosure 7
Page 3 of 3
FEDERAL GRANT DETAILED PROGRAM BUDGET STATE FISCAL YEAR: 2016 – 2017
TYPE OF GRANT: MHBG
COUNTY: FRESNO SUBMISSION DATE: July 1, 2016
FISCAL CONTACT: Laurentius Harlan Theng PROGRAM CONTACT: Susan Murdock, Program Director
TELEPHONE NUMBER: (559) 600-4619 TELEPHONE NUMBER: (559) 600-4876
EMAIL ADDRESS: lharlantheng@co.fresno.ca.us E-MAIL ADDRESS: smurdock@co.fresno.ca.us
PROGRAM NAME: Juvenile Justice SED Dual Diagnosis Outpatient Program – Contract Mental Health Systems, Inc.
STAFFING 1 2 3
ANNUAL GRANT
LAST
APPROVED REQUEST OR
TITLE OF POSITION SALARY FTE BUDGET CHANGE TOTAL
1 Program Manager $ 62,920 0.35 $ 22,022 $ 22,022
2 Administrative Assistant- FFSAU $ 29,537 0.30 $ 8,861 $ 8,861
3 Clinical Supervisor - LCSW $ 65,416 0.56 $ 36,633 $ 36,633
4 Unlicensed MH Clinician - Girls $ 46,696 1.00 $ 46,696 $ 46,696
5 Unlicensed MH Clinician - Boys $ 24,960 1.00 $ 24,960 $ 24,960
6 Unlicensed MH Clinician - Boys $ 38,480 1.00 $ 38,480 $ 38,480
7 Vice President $ 84,000 0.05 $ 4,200 $ 4,200
8 Program Analyst $ 58,760 0.10 $ 5,876 $ 5,876
9 Benefits (State Unempl Ins., OASDI, Life, Health Ins., Worker’s Comp) $ 40,017 $ 40,017
10 Payroll Taxes (F.I.C.A.) $ 14,361 $ 14,361
11 $-
12 TOTAL STAFF EXPENSES (sum lines 1 thru 11) $410,769 4.36 $- $ 242,106 $ 242,106
13 Consultant / Contract Costs (Itemize):
14 Interpreter Services $ 6,000 $ 6,000
15 $-
16 $-
17 Equipment (Where feasible lease or rent) (Itemize):
18 Equipment Purchases < or = to $1,000 $ 255 $ 255
19 $-
20 Supplies (Itemize):
21 Office Supplies $ 600 $ 600
22 Program Supplies – client education & snacks $ 2,000 $ 2,000
23 Postage & Freight $ 100 $ 100
24 $-
25 $-
26 Travel -Per diem, Mileage, & Vehicle Rental/Lease
27 $ 5,423 $ 5,423
28 Other Expenses (Itemize):
29 Professional and General Liability Insurance $ 1,950 $ 1,950
30 Staff Development and Training $ 500 $ 500
31 Software Expense $ 1,025 $ 1,025
32 Licenses and Taxes $ 1,500 $ 1,500
33 Prof. Fees/Acctng/Bank Charges/Other Business Svcs (new hire screen, etc.) $ 450 $ 450
34 Equipment Repair/Maintenance $ 100 $ 100
35 Program indirect Costs (HR, Accounting, QI, IT and Facilities) $ 37,991 $ 37,991
36 Utilities, Janitorial, Security, and Janitorial Supplies (incurred in County's Budget) $ 10,000 $ 10,000
37 COUNTY ADMINISTRATIVE COSTS (10% MHBG) $ 30,000 $ 30,000
38 NET PROGRAM EXPENSES (sum lines 12 thru 37) $- $ 340,000 $ 340,000
39 OTHER FUNDING SOURCES: Federal Funds
40 Non-Federal Funds
41 TOTAL OTHER FUNDING SOURCES (sum lines 39 & 40) $- $- $-
42 GROSS COST OF PROGRAM (sum lines 38 and 41) $- $ 340,000 $ 340,000
DHCS APPROVAL BY:
TELEPHONE:
DATE:
DHCS 1779 (06/16)
Page 15 of 31
PROGRAM NARRATIVE
County of Fresno Department of Public Health
Jail Psychiatric Services Program
By Corizon Health, Inc. - Contractor
FY 2016-2017
A. STATEMENT OF PURPOSE
Fresno County has a population of over 974,861 people and encompasses almost 6,000
square miles. It has one of the most culturally and ethnically diverse populations in California
with over 105 different languages spoken in its homes (Fresno County United Way 1998).
Unemployment in the County in the past year averaged 9.8%, which is the lowest it has been in
seven years yet still exceeds the State (5.8%) and National (5.0%) average. In 2015, the
Fresno-Madera Continuum of Care Point-in-Time (PIT) count found 1,722 homeless individuals
in Fresno County. The County of Fresno Adult Detention Facilities has an average daily
population of 2,674 inmates. On any given day, an estimated 25% of the jail population suffers
from a severe mental illness with around 75% to 85% of these inmates having a co-occurring
substance use disorder problem.
“… studies indicate that rates of serious mental illness are at least 3 to 4 times higher than the
rates of serious mental illness in the general population [in jails]. Many of the mentally ill
inmates are in jail because of their symptoms. When incarcerated, people with untreated
mental illness are especially vulnerable to assault or other forms of intimidation by predatory
inmates.” (Criminal Justice/Mental Health Consensus Report 2002). Also, the County jail
environment can itself exacerbate the symptoms of the mentally ill, which increases the
likelihood of further impairment of functioning as well as physical risk.
The need for a jail-based mental health program is evident. Jail Psychiatric Services (JPS)
provides a 24-hour, 7-day a week mental health service delivery system. The program is
designed to identify and stabilize mentally ill inmates, and to identify and stabilize those inmates
that have co–occurring mental illness and substance use problems.
MEASURABLE OUTCOME OBJECTIVES
The mission of the Jail Psychiatric Services program is to provide a jail-based 24-hour, 7-day a
week mental health program in the County of Fresno Adult Detention Facilities.
Objectives:
1. Serve 3,000 unique inmates between July 1, 2016 and June 30, 2017.
a. Provide psychiatric staff for medication management services as well as other
clinical nursing staff to successfully treat this population.
b. Provide psychiatric evaluations for an average of 250 inmates per month.
c. Enroll 270 unique inmates in group treatment specifically for individuals with co-
occurring disorders of mental illness and substance use.
d. Provide discharge plans for 200 unique inmates.
2. Serve 662 unique inmates identified as having co-occurring disorders of mental illness
and substance use.
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a. JPS will document the number of inmates that will receive dual diagnosis
treatment.
3. Work with other county programs to link 30 inmates to intensive case management
follow up programs either through the Behavioral Health Court in Fresno County, or to
treatment programs for dual diagnosis.
Objectives Achieved by JPS for FY 2015 - 2016
1. About 3,400 unique inmates were provided services when 2,880 were projected to be
served in the FY 15-16 application. This exceeded the expected outcome. An average
of 166 inmates per month were evaluated by psychiatrists working with the program
when 360 were projected. This figure is lower than predicted. It appears that due to
reduced bed capacity and variable turnover (i.e., inmates with more serious charges
being held, while inmates with less serious charges tend to be released due to
overcrowding), some inmates are staying longer in the jail. This may be a causative
factor in the lower number of assessments, since each inmate is only given one
assessment per incarceration, and further services by a psychiatrist are considered to be
follow-up sessions.
2. During FY 2015-2016, approximately 60 inmates were enrolled in group treatment
beginning in May 2016, which was a significant decrease compared to the objective of
270. These numbers were seen to be higher than the previous year (zero) but less than
the objective. This was likely the result of the development of the group process
necessitating the purchase and installation of safety equipment in order to conduct
effective group therapy.
3. Future year’s objectives take into account the increasing population in the jail, despite
the continuing pattern of releases due to overcrowding. Additional effort will be made in
the coming year to reach all objectives, anticipating that budget resources are unlikely to
improve before 2017.
4. About 550 unique inmates were identified as having co-occurring disorders of mental
illness and substance use, a decrease in the objective of 662.
5. Programs in the community continued to face downsizing and resource reduction during
the year, resulting in some loss of programs altogether. Funding cuts affecting the
Department of Behavioral Health necessitated closure of programs, outsourcing of
inpatient capacity, and restriction of services to a target population carrying only those
diagnoses meeting the criteria of Serious Mental Illness. At the same time, jail
overcrowding prompted a move towards cite and release of arrestees with non-violent
crimes, putting many of the dual diagnosed individuals with lesser charges back out into
the community at booking. These factors contributed to the reduction of appropriate
placements into treatment programs directly from the jail. However, about 167 inmates
were referred to Turning Point Full Service Partnerships, Department of Behavioral
Health Urgent Care Wellness Center, Co-Occurring Disorders Treatment Program, and
Veteran’s Administration.
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Going forward into FY 2016 - 2017, it is clear that the stability and availability of residential
dual diagnosis programs continues to be limited. Therefore, it is not likely to yield useful
information as an outcome measure. Continued effort will be focused on working with
structures such as the Behavioral Health Court to develop alternative placements to
incarceration that include dual diagnosis treatment, regardless of whether this is residential
or "outpatient" treatment. Continued effort with effective Discharge Planning will be made
for those who do meet the criteria for a dual diagnosis program on a case by case basis.
B. PROGRAM DESCRIPTION
The Jail Psychiatric Services program provides a variety of treatment options in the jail setting
based on community standards for outpatient services. These include the following:
• Evaluation and assessment, including dual diagnosis
• 24-hour crisis intervention
• Medication management, including management of dual diagnosis issues
• Referral for acute psychiatric hospital care
• Consultation with correctional officers to determine appropriate housing
• Monitoring of the safety and isolation cells for the mentally impaired inmates
• In-house dual diagnosis program and coordination with the Behavioral Health Court
to facilitate alternatives to incarceration.
• Group treatment specifically designed to address dual diagnosis issues
• Referrals from Behavioral Health Court. Staff representation in BHC Monthly
meetings to assist with continuity of care.
• Development and implementation of behavioral plans to change problematic
behaviors
All inmates are initially screened at booking by medical staff to determine their immediate
mental health needs. Many of the inmates referred to Jail Psychiatric Services come from this
initial screening at booking. However, inmates can refer themselves directly. Other referral
sources are family, courts, and correctional officers.
The modified in-house dual diagnosed program provides treatment through the multiple
activities involving identification, assessment, medication management, dual diagnosis groups,
and linkage to other resources when possible. The treatment is coordinated by JPS staff
through a team approach. The team meets daily to provide coordination and consistency in
treatment which are highly recommended in dealing with dual diagnosis issues. By maintaining
a coordination of care through the team approach, treatment goals can be identified and
achieved efficiently.
JPS continues the policy and procedure for providing a contact line to be exclusively used by
the community to provide information pertaining to the care and welfare of inmates. In 2006,
members of the Mental Health Board of Fresno County identified a need for family members to
be able to relate information to JPS staff regarding incarcerated family members and JPS
responded to this need by installing two contact lines (one telephone and one facsimile) for this
purpose. The use of this line has expanded over the years, and attorneys now leave messages
of concern regarding health of their clients and requests for assistance with possible dual
diagnosis issues.
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The need for continued identification and linkage to alternatives to incarceration is evident.
Once discharged, detainees can be referred directly to the Department of Behavioral Health’s
outpatient treatment programs or can be placed in other appropriate levels of care for those
inmates diagnosed with Serious Mental Illness (Schizophrenia, Bipolar Disorder, Major
Depression with Psychotic Features, Post-Traumatic Stress Disorder and Schizoaffective
Disorder). JPS has advocated for inmates who have participated in the program to attend dual
diagnosis programs outside of the jail (such as West Care in the Fresno area) once they are
discharged. Many of these programs are struggling with budget issues, and are no longer
available as resources. Identification of new program resources is a continuing effort.
Additional resources, both residential and outpatient are priorities for development for the
Department of Behavioral Health this year, which may provide opportunities for linkage in the
future.
JPS staff and management have collaborated with the local Superior Court, the District
Attorney's office, the Public Defender's office, the Probation Department and the Department of
Behavioral Health in operating a Behavioral Health Court in Fresno County. The Jail
Psychiatric Services Community Mental Health Specialist attends the pre-court multidisciplinary
meetings twice a month, to promote continuity of care, provide technical assistance, and
discuss referrals to the court. This specialized court began operations in the summer of 2008.
This court works with multiple resources, including Full Service Partnerships that can provide
intensive case management and "whatever it takes" approaches to maintaining individuals in
the community rather than in jail. These resources may also be able to provide levels of care
that formerly were only available in residential settings. The court has accepted referrals of
mentally ill inmates who have non-violent felonies, for consideration of sentencing to probation
in the community, with court monitored involvement in treatment, education, and intervention for
dual diagnosis issues. In 2011, the court has expanded its acceptance criteria to include some
misdemeanor cases. This approach may provide more positive outcomes for dually diagnosed
individuals who would otherwise have repeated contacts with law enforcement, may reduce
costs, and may increase the likelihood of successful integration into long term, self-sufficiency.
The court is currently in its seventh full year of operation.
Clients at the jail receive individualized treatment by a multi-disciplinary team based on the
existence of co-occurring disorders and the need for simultaneous treatment of the symptoms
presented (Integrated Treatment Model). The management of clients through the program
includes the following processes: 1) referral, 2) engagement of client, 3) assessment procedure,
4) psychiatrist evaluation, 5) case manager assignment (clinician or nursing staff), 6)
completion of paperwork, and 7) follow-up.
Fresno County began group treatment programs in November of 2008 for the dually diagnosed
inmates. The target population is those individuals incarcerated that have a history of/or can be
diagnosed with co-occurring disorders. The groups consist of up to 15 individuals who have
been screened and meet the admissions criteria to participate in the group sessions. The
groups are co-facilitated by JPS staff who have knowledge of co-occurring disorders and who
are able to effectively provide the specific intervention. The groups are available on “open-
ended” enrollment. This allows for qualified individuals to receive the services without a lengthy
delay. Length of stay in the Fresno County jail is quite variable, depending upon numerous
factors such as level of offense, bail amount, releases due to overcrowding, and other factors
beyond the control or prediction of JPS. Therefore, it is important to provide prompt access to
treatment for this fluid population.
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Referral
Referrals within the jail system usually come from custody officers, self-referral at booking,
requests for service by inmates in the general jail population, attorneys, judges, or by program
staff working with the inmates in regard to known medical and/or psychiatric issues The clients
are then assessed for suitability by the JPS staff, and accepted into treatment if their diagnosis
indicates that need.
Engagement
Program staff goes to the inmate, either within the jail pod setting, booking area, or infirmary
areas in order to engage the inmate into dual diagnosis services. This process is often in
combination with, or as a direct result of, assessment of the inmate.
Assessment Procedure
Multidisciplinary staff uses structured interview, clinical interview, and inmate history to
establish diagnosis and need for services. Assessment can be ongoing during an inmate’s stay
at the jail. Engagement into services is often initiated as part of the assessment process. All
referrals that appear to be willing and appropriate for services receive an assessment by a
psychiatrist.
Psychiatrist Evaluation
Upon referral from custody, mental health, or medical staff, psychiatric evaluation is provided
within the jail setting. Psychiatric evaluation may include chart review, face-to-face interview,
tele-medicine interview, multidisciplinary consultation, and review of information from custody.
Based on the results of evaluation, the inmate with dual diagnosis issues may be started and/or
maintained on appropriate medications and follow up support from mental health staff and
psychiatric staff. Options range from ongoing supportive contacts to medication support, to
placement in safety cell or higher level of care outside the jail, depending upon the needs of the
inmate. Inmates who present at the jail with existing medication treatment programs are
evaluated as a priority by the psychiatrists, and existing medication programs may be
continued, modified, or discontinued as determined by the psychiatrists.
Case Manager Assignment and Follow-up
Consumers who are willing to be engaged into treatment are assigned a case manager who is
responsible for providing follow up contacts within the jail setting. Depending upon the
treatment needs, inmates may continue to follow-up with a psychiatrist for
monitoring/adjustment of medications and with a staff clinician or mental health worker for
supportive contacts, including development and implementation of discharge plans.
C. TARGET POPULATION
It is expected that the program will serve approximately 2,200-2,600 unduplicated inmates in FY
2016-2017. Of this number, 900-1000 will be provided services to address dual diagnosis
issues. MHBG funding will be used to provide treatment to this population. The inmates treated
in this program must have a primary mental diagnosis that impairs their ability to function and a
secondary substance-related disorder. The co-occurring disorders must prevent the individual
from benefiting from traditional mental health services and chemical dependency services.
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An inmate who is actively psychotic or in a current mood episode to the extent that it would
prohibit them from participating in the dual diagnosis program, will be stabilized on medications
before participation is permitted.
All services will be inclusive of cultural and language capabilities to engage and maintain
treatment populations that have been historically underserved. JPS staffing includes bilingual
staff, providing linguistic and culturally competent services in Spanish and Hmong. The
program has interpreter resources available to insure that language barriers are addressed in
assessment and treatment. Every effort will be made to provide psycho-education and
individual treatment programming options with staff that are competent in the culture and
language of the treatment population.
D. STAFFING
Outside Provider of Service – Corizon Health, Inc.
Licensed Psychiatrist, Licensed Mental Health Worker Supervisor, Licensed Mental Health RN,
Unlicensed Mental Health Specialist, Office Assistant III, Medical Assistant, Licensed
Professional Counselor, Psychiatric Aide/Associate (LPT).
CULTURAL COMPETENCY
Fresno County is a multicultural community. Threshold languages are English, Spanish, Lao,
Cambodian, and Hmong. Historically, there has been a consistent request and demonstrated
need for dual diagnosis services for Spanish monolingual consumers. The design of JPS
includes multicultural concepts. Threshold language services will be available through
multicultural staff and interpreters.
Consumers entering JPS will be assessed by licensed mental health staff. Part of that
assessment will include focus on natural support systems and cultural strengths that can be
interwoven with treatment. Ongoing assessment of individuals will focus on functioning in the
program and relating to the ethnic and social support systems appropriate for recovery.
Title VI of the Civil Rights Act of 1964 clearly specifies the efforts required for providing
culturally and linguistically appropriate services for consumers accessing health systems such
as JPS. Providing language assistance or having program staff with language capability,
involving natural support systems, maintaining a cultural focus during the assessment and
treatment planning and carefully evaluating each consumer’s cultural strengths will go hand in
hand with outreach to the culturally diverse target populations. The objectives of Title 15 of the
California Code of Regulations also indicate that those in a detention facility should be afforded
the same opportunity for treatment as those not incarcerated, to the extent that resources allow.
E. DESIGNATED PEER REVIEW REPRESENTATIVE
The designated peer review representative for this project is the Director, Fresno County
Department of Behavioral Health.
F. IMPLEMENTATION PLAN
The Jail Psychiatric Services dual diagnosis program was completely staffed and fully
implemented in January 2002. As of June 23, 2014 staffing levels were changed to meet
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Corizon/Fresno County Agreement for services and has been fully staffed for the FY 2014-
2015. A plan to increase mental health staffing levels to address SMI population by 5.3 FTE as
of August 1, 2015 has been approved by Fresno County Board of Supervisors as of July 14,
2015. The program is completely staffed as of February 2016. Ongoing review of needed
staffing levels continues based on the needs of the facility and the increasing severity as well as
number of those with SMI being incarcerated.
G. PROGRAM EVALUATION
JPS monitors program operations and goals on an ongoing basis. Program objectives are
monitored by assigned staff. Client information stated in the Measurable Outcome Objectives
section is tracked through computer database and Microsoft Excel software. Staff monitor: 1)
inmates treated in all programs, 2) inmates diagnosed as having co-occurring disorders of
mental illness and substance use, and 3) referrals to Behavioral Health Court and other
programs in the community. The information is kept in a de-identified manner for review by the
Program Administrator on an ongoing basis. Qualified translators will be used to augment
bilingual/bicultural delivery of services when appropriate. Program activities are monitored
during quarterly onsite multidisciplinary meetings. In the event there are program problems or
barriers to care identified, the committee and assigned staff are responsible for developing a
plan of resolution.
H. OLMSTEAD MANDATE and the MHBG
Typically the most formal method of aftercare planning for SMI inmates is for those that have
been identified through the Behavioral Health Court. These individuals are brought to the
attention of Mental Health staff while incarcerated as being eligible to receive services as a
function of sentencing or alternative planning. The Mental Health Specialist works closely with
case managers, attorneys and probation officers through the court to arrange post incarceration
treatment for both residential or outpatient programs. These individuals are typically picked up
upon order of the court by probation or program officials and transported to the designated
program. This also affords the program officials to pick up the 7 day supply of medications from
the pharmacy in the event the patient/inmate is receiving medications.
In the case of inmates who are receiving medications while incarcerated whether or not they
are SMI; a 7 day supply of medications is available to them for pick up through CVS.
Jail health care staff provides discharge planning for sentenced inmates with serious mental
health disorders, including connecting such inmates to community health care providers,
community social services, community-based housing, and/or appropriate services per the
individual’s need. Inmates receive a summary of intended services as part of the Discharge
Plan, which is initiated at the initial Mental Health Evaluation and is updated through the stay by
the Mental Health Staff. Appointments are identified or arranged for pertaining to medical and
psychiatric services prior case arrangement and major concerns upon release. Natural
resources are also identified as well as inmate desires for setting up appointments in areas
such as housing, shelter needs, food resources, anger management, job assistance, education
or recovery programs. Also included are important contacts such as probation or parole officers
as well as attorneys.
Lastly, contact information is provided to the Urgent Care Wellness Center in a pamphlet
inmates receive upon discharge.
Page 22 of 31
JUSTICE MULTI-AGENCY PROGRAM (MAP) POINT
The County’s Department of Behavioral Health seeks to streamline access processes to ensure
that all individuals in need of behavioral health care have a timely, personal, relevant, clear and
understandable path to care. By integrating behavioral health into other systems such as
physical health settings, justice settings including courts and probation, schools and other
service delivery organizations, the County can significantly increase access to care and
improve the total health and wellness in the community.
As of June 2016, the County is currently in the request for proposal (RFP) process to seek
contractors who will operate MAP Points in order to provide an integrated screening process
connecting individuals and families facing mental health, substance use disorder, physical
health, housing/homelessness, social service and other related challenges to supportive service
agencies in Fresno County. The MAP Points identified through the RFP process will be
established at optimal strategic and geographic locations that have dense client flow to target
underserved and unserved populations with critical access needs. The County intends to
identify a contractor who agrees to operate a Justice MAP Point at the Adult Detention Facility
in an effort to supplement the discharge planning services provided by Corizon’s Jail Psychiatric
Services program as well as implement continuity of care after discharge. MHBG funds will not
be used for the Justice MAP Point.
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PROGRAM NARRATIVE
Fresno County Department of Behavioral Health (DBH)
Children’s Mental Health Division
Juvenile Justice SED Dual Diagnosis Outpatient Program
By Mental Health Systems Inc. (MHS) - CONTRACTOR
FY 2016-2017
A. STATEMENT OF PURPOSE
The Juvenile Justice Campus (JJC) both detention and commitment was opened on July 22,
2006. The JJC is located on the southwest corner of Freeway 99 and American Avenue and
consists of a 180 bed detention facility for those minors going through the court process; and a
210 bed commitment facility for those minors formally sentenced by the Juvenile Court to a
specific treatment program. The design and philosophy of the JJC has provided the opportunity
for new programs and approaches to detention and commitment programs. The JJC receives
minors in custody from numerous different agencies in the County of Fresno. This includes
minors transferred to Fresno County from other jurisdictions and state agencies. The facility
has allowed the flexibility to house its population in specialized groupings according to criminal
sophistication, age, gender, and court status. The result has been an ability to more easily
target and manage populations within the facility.
It is well documented that a majority of the youth entering juvenile halls have mental health
problems and many have co-occurring mental health and substance use issues. In fact, facility
personnel say it is uncommon to see mentally ill youth in local custody who are not also using
some substance or substances. Trauma is also a significant issue for probation youth since
most if not all have experienced critical incidents of one sort or another at some point in their
lives. (MENTALLY ILL JUVENILES IN LOCAL CUSTODY ISSUES AND ANALYSIS JUNE,
2011)
Youth are assessed and referred to the Floyd Farrow Substance Abuse Unit (SAU) through the
Fresno County Juvenile Court and/or Fresno County Probation. MHS provides each youth and
his/her family with a multi-disciplinary team, including a mental health clinician, substance
abuse specialist and a family support partner. This program combines the most effective
aspects of therapeutic community with a curriculum proven effective with incarcerated
substance abusers. MHS provides life-enhancing recovery options that include integrated
services related to alcohol and drug addiction and other behavioral health disorders. The goal
is to maintain treatment components that are empathic, ethical, trauma-informed, culturally
competent and gender-responsive, while delivering a professional attitude in all phases of care
and remaining dedicated to creating an environment of opportunity, choice, and hope. Services
include group therapy, individual therapy, multi-family groups, psycho-education, life skills,
anger management, art and recreational therapy, case management and family therapy.
Adolescent and their family are transitioned as needed to MHS post-release services for an
additional 120 to180 days out of custody. MHS goal is to involve the whole family in the
treatment process to enhance the probability of sustained success.
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*Source: Fresno County Probation Department Annual Report 2013 – 2014
*(most recent data available)
B. PROGRAM DESCRIPTION
Intensive services by Mental Health Systems, Inc. (MHS) targets adolescents who are in-
custody at the County’s Juvenile Justice Campus (JJC). Post-release services are also
provided upon completion of the in-custody program as adolescents transition back into the
community. There is capacity at the JJC to serve 40 in-custody adolescents at any given time.
FLOYD FARROW SUBSTANCE ABUSE UNIT (SAU)
In-custody treatment consists of dual diagnosis services for thirty (30) males and ten (10)
females, a distribution reflective of the target population, in a full scope gender-responsive
therapeutic community treatment model. In-custody program duration is six (6) months.
Progress and completion of the program is based upon a level and phase system.
While in the SAU a range of services is provided to every adolescent and family incorporating
the following elements:
1.Completion of a comprehensive mental health assessment by a clinician upon intake. If
needed, referrals for psychotropic medication evaluation are made to Corizon Staff at the
Fresno County Juvenile Justice Campus. Corizon is responsible for evaluation, prescription,
administration, and oversight of psychotropic medications.
2.Treatment services that are centered on a multidisciplinary treatment team of mental health
and substance use, school, and probation staff that coordinates the treatment plan to
address the multiple needs of adolescents and family.
3.Family involvement is crucial to the adolescent’s success, especially because most
adolescents return home after incarceration or live at home during outpatient treatment. As
such, the multidisciplinary team engages the family upon their adolescent’s intake to the
program with a welcome phone call from MHS Family Support Partner, who provides the
family with information on all the program’s many opportunities for family support, including
transportation to and from weekly family groups and bi-weekly family therapy sessions.
MHS Family Support Partner also provides referrals to all family members for any available
resource in the Fresno community that would strengthen and benefit the family.2762 2374 2068 2031 644 545 496 487 0
500
1000
1500
2000
2500
3000
2011 2012 2013 2014
Male Bookings
Female Bookings
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4. Curriculum is adjusted to the adolescent’s developmental needs and to meet educational,
cultural, and gender specific requirements. Certain values and structures must be
maintained to support the effect of group-based programs, but each treatment plan is
individualized.
5. Integration of extracurricular and therapeutic activities is offered to stimulate interest while
supporting the message that sobriety can be fun and meaningful. These activities may
include talent shows, holiday celebrations, after-care field trips, family potlucks and
barbeques as a means of engaging clients and families. Adolescents in the SAU and their
families experience an atmosphere of acceptance and trust, demonstrated by the number of
families involved in the program.
6. Commitment to teams of mental health clinicians and MHS substance abuse counselors
with a low client-to-staff ratio and a wide range of diversity and expertise to improve client
outcomes, including staff gender and ethnic/cultural diversity, is consistently demonstrated
in staffing. Further, MHS requires that all staff participate in ongoing cultural competence
staff training.
7. MHS provides a Post-Release Outpatient Services program (PROPS) to address the mental
health and substance use issues of the adolescents after discharge from the Juvenile
Justice Campus.
A challenge for clients participating in an in-custody program is the transition back into the
community. Moving from a highly structured, secured setting like the JJC to an environment
that supported addiction and delinquent behavior can be stressful and highly problematic.
Many times adolescents return to homes in which family members are engaged in behaviors
that the adolescent is trying to avoid, or to gang activities that do not foster newly developing
healthy, crime-free lifestyles. To help assure post-release stability, in-custody treatment
services are designed to help adolescents build and internalize skill sets that will sustain their
commitment to sobriety during and after the transition phase. Program structure and proven
interventions at the SAU include:
• Therapeutic Community (TC): True recovery is a process that occurs within a healing
community. This approach puts participants in a setting that teaches, rewards, and
reinforces the pro-social skills and outlooks necessary for successful reintegration into
society. It also addresses negative attitudes and behaviors by a series of interventions,
learning experiences and possible disciplinary measures including temporary exclusion from
the community, depending on the severity of the conduct. The SAU in-custody program
combines strong and intensive treatment with the tools of the TC to affect cognitive,
emotional, and behavioral restructuring of participating adolescents. Only by such a
complete restructuring of beliefs, attitudes, and behaviors is it possible to avoid relapse and
recidivism. Through the TC adolescents also learn how to develop positive relationships
supportive of a drug-free, crime-free lifestyle; these acquired skills can then be successfully
used once released from custody.
• Motivational Interviewing (MI): In addition to Therapeutic Community, MHS also utilizes
MI, as a means of engaging and motivating adolescents and families. MI is an evidence-
based interactive counseling approach proven effective in assisting individuals and families
to mobilize internal resources for change by enhancing intrinsic motivation. Program staff
are trained in MI counseling style, including interviewing and brief intervention techniques,
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and use of the stages of change theory (which include stages of pre-contemplation,
contemplation, preparation, action, and maintenance).
•Gender-Responsive Services: MHS recognizes that gender makes a difference and
gender responsive treatment is a critical component of success in all aspects of substance
use and mental health treatment. To this end, females participate in a specialize treatment
program designed to deal with the complex familial and relationship issues unique to
adolescent females with substance use and mental health issues. To help female
adolescents admitted to the in-custody program explore their unique traits, strengths, and
self-images, MHS incorporates Brene Brown’s curriculum, “Shame Resiliency,” and
Stephanie Covington’s curriculum, “Voices.” Every effort is made to identify an exclusive
sustainable environment especially for female’s treatment and supportive activities as a
means of enhancing gender responsiveness. At every level of care, specific treatment
interventions are utilized to meet both male and female gender-based needs. For instance,
during the in-custody treatment phase, Hazelden’s curriculum, “Young Men’s Work” equips
adolescent males with the ability to form positive relationships with both men and women
with all creeds and colors.
•Screening and Assessment: SAU continues to use the Adolescent Assessment of
Severity Index (Y-ASI) for adolescents admitted to the program. In collaboration with
Fresno’s Juvenile Court, SAU performs this screening to expedite availability of the
information. SAU counselors also administer the ASAM PPC II for each client. The mental
health clinician completes a comprehensive mental health assessment upon placement in
the program, and conducts a Child and Adolescent Needs and Strengths (CANS)
Assessment at intake, 6 month reassessment, Transition/Discharge, and Plan of care
update.
•Dual Services Team: Each group of 15 minors in the SAU has a professional team
composed of MHS Mental Health Clinician and MHS Substance Abuse Counselor. The
team provides coordinated treatment and case management during the in-custody phase of
the program. This team co-facilitates therapy groups that address substance use and
mental health issues.
•Treatment Team: The team consists of individuals significantly involved in the adolescent’s
treatment, including the adolescent, family, mental health and substance abuse counselors,
probation officer, JJC and education staff, MHS Family Support Partner, and others who
may be involved in the adolescent’s aftercare plan. The treatment team approves the
treatment plan within 30 days of admission and reviews and modifies plan every 90 days, or
as needed. The treatment team reviews progress in the program on a bi-weekly basis.
•Treatment Plan: The initial treatment plan is developed by the adolescent, adolescent’s
family, the clinician, and counselor within the first 30 days of admission, integrating
information from the mental health assessment. The plan is reviewed by the full treatment
team for approval and is updated as needed or at least every 90 days.
•Treatment Services: Treatment components include individual mental health therapy,
family therapy and counseling, process groups, community groups and psycho educational
groups, discharge planning, case management, and recreational and social activities.
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Progress in the SAU program is demonstrated through movement through a level and phase
system. Movement from one level to the next requires passing milestones, including peer panel
interviews. This ensures that the adolescent feels that he/she has earned the promotion, and
that his/her achievements have been acknowledged. Successful completion of the program is
finalized with a graduation ceremony, which is a positive, re-affirming event that includes family
members, the treatment team, and others in the adolescent’s community.
POST-RELEASE OUT PATIENT SERVICES (PROPS)
Upon successful completion of the in-custody SAU program adolescents are returned home to
their families and those identified as needing post-release out-patient services begin the second
phase process of recovery. The six-month post-release program provides intensive out-patient
services. The continuity of service allows clinicians to develop a consistent and longer term
therapeutic relationship with the adolescents and their family (6 months in-custody, 6 months
post-release). This consistent and stable relationship between client and clinician assists in
maintaining stability, family participation and treatment compliance as the client reintegrates
into their community and peer culture.
The PROPS program provides the following services:
• Intensive substance abuse treatment services
• Individual and family therapy and mental health services as needed;
• Crisis intervention;
• Case management provided by the multidisciplinary team;
• Process and family groups, ancillary referrals, educational/vocational assistance, Life
Skills curriculum, coordination of clean and sober activities, educational forums, and
family centered activities;
• Information and referral to community-based 12-Step programs;
• Opportunities for community service work; and
• Clean and Sober social and recreational activities.
C. TARGET POPULATION
The target populations are adolescents diagnosed as severely emotionally disturbed (SED) who
have a co-occurring substance use disorder diagnosis, and are either in-custody at the Juvenile
Justice Campus or are in the Post-Release Outpatient services component. Mental health staff
works very closely with the substance abuse counselors. Each juvenile is assigned to a team
consisting of both clinician and a substance abuse counselor. This team is responsible for
providing services to the juvenile and his/her family throughout treatment. The assigned team
follows the family through all phases of treatment, including PROPS, and is available as needed
during periods of crisis, instability and challenges. Part of the Clinical Supervisor’s time, not
funded by SAMHSA Community Mental Health Services Block Grant (MHBG), involves
oversight of substance abuse staff, ensuring effective, coordinated and integrated delivery of
treatment services.
D. STAFFING CHART
SAMHSA MHBG FY 2016-17 funds co-occurring mental health and substance use disorder
contracted services which are provided by a community provider, MHS, at the Juvenile Justice
Campus. The amount of $300,000.00 will fund salaries and benefits and operating expenses
associated with the provision of the co-occurring disorder program provided by MHS. The
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amount of $40,000.00 will fund County costs for utilities, janitorial, security and supplies at JJC
as as well as administration of the program and MHBG.
Outside Provider of Service – MHS
Total grant FTE 4.36
Vice President is responsible for overall oversight.
Program Manager reports to the Vice President and is responsible for program oversight.
Program Analyst is responsible for financial, support services, project coordination, and
program’s budget maintenance.
Administrative Assistant is responsible for administrative and clerical support to the clinical
team.
Clinical Supervisor reports to the Program Manager and is responsible for the clinical
supervision of the three unlicensed clinicians and four mental health interns (this program has
become a teaching program, providing the opportunity for several Master’s interns MSW and
MFT from Fresno State University, University of Phoenix, National University, and University of
Southern California to complete their internship). In addition, the Clinical Supervisor manages a
case load of five adolescents, assists in monitoring SAMHSA MHBG funded positions, data
collection and evaluation, treatment planning, assessments, crisis, collaboration, and provides
hands-on supervision.
Unlicensed clinicians report to the Clinical Supervisor and each carries a case load of 10-15
adolescents (in-custody) and up to 10 adolescents in PROPS (post-release). Each provides
case management, aftercare, home visits and linkages necessary for community transition.
E. DESIGNATED PEER REVIEW REPRESENTATIVE
The designated peer review representative for this project is the Director, Fresno County
Department of Behavioral Health.
F. IMPLEMENTATION PLAN
The co-occurring disorder treatment program is fully implemented.
G. PROGRAM EVALUATION PLAN
Monthly service reports include the number of minors served and services provided. Monthly
outcome reports delineate number of minors’ outcome while completing the program. Program
staff continues to identify and resolve problems as encountered by the program through
communication and collaboration internally, as well as with community partners.
CLIENT OUTCOME OBJECTIVES
During FY 2015-2016, 60 Adolescents had been served. It is anticipated 80 adolescents will be
served during FY 2016-2017.
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Program objectives for adolescent participants of the SAU and PROPS program in FY 2016-
2017 are:
Participants will be drug free six months after completion of in-custody program;
Participants will have no new convictions during first six months after completion of in-
custody program; and
Participants will be attending school, working, or engaged in a vocational program six
months after completion of in-custody program.
PROGRAM DATA
Data includes provision of services by MHS July 1, 2015 through May 20, 2016.
SUBSTANCE ABUSE UNIT: IN-CUSTODY
Outcome I: Participants will be drug free six months after
completion of in-custody program
2014-15 2015-16 Projected
2016-17
1.Number of Participants that Reached Six Month Marker 67 56 80
2.Number who are Clean During Last Three Months 54 50 72
3.Percent of Clean Participants at Six Months 80% 90% 90%
Outcome II: Participants will have no new convictions
during first six months after completion of in-custody program
2014-15 2015-16 Projected
2016-17
1.Number of Participants that Reached Six Month Marker 67 56 80
2.Number who have No Convictions the First Six Months 62 54 76
3.Percent of Participants with No Convictions 93% 97% 95%
Outcome III: Participants will be attending school, working,
or engaged in a vocational program six months after
completion of in-custody program
2014-15 2015-16 Projected
2016-17
1.Number of Participants that Reached Six Month Marker 67 56 80
2.Number of Adolescents in Ed. Program/Voc.
Prog./Working
63 54 72
3.Percent of Participants Working or In Ed/Voc Program 94% 90% 90%
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SUBSTANCE ABUSE UNIT: PROPS (POST RELEASE OUTPATIENT SERVICES)
Outcome I: Participants will be drug free at completion of
PROPS program
2014-15 2015-16 Projected
2016-17
1.Number of Participants that reached completion of
program
14 7 18
2.Number who are Clean During Last Three Months 10 7 14
3.Percent of Clean Participants at Six Months 71% 100% 78%
Outcome II: Participants will have no new convictions during
first six months after completion of PROPS program
2014-15 2015-16 Projected
2016-17
1.Number of Participants that Reached Six Month Marker 14 7 18
2.Number who have No Convictions the First Six Months 11 7 16
3.Percent of Participants with No Convictions 78% 100% 89%
Outcome III: Participants will be attending school, working,
or engaged in a vocational program six months after
completion of PROPS program.
2014-15 2015-16 Projected
2016-17
1.Number of Participants that Reached Six Month Marker 14 7 18
2.Number who are attending school, a vocational program,
or working the First Six Months
13 7 16
3.Percent of Participants attending school, a vocational
program, or working
92% 100% 89%
H. OLMSTEAD MANDATE and the MHBG
The goal of MHS is to assist youth with co-occurring disorders (COD) who spend the initial
phase of their treatment in-custody to be transitioned successfully back to their families and
care-givers with services that meet their individualized needs. Additionally, the goal is to
prevent them from being institutionalized and to assist them with on-going services and
referrals to services that will provide them and their families with the resources to be successful
in all areas of their life.
IMPLEMENTATIONS
•Housing services: The majority of youth participating in the program live with parents or
caregivers. MHS’ team of clinicians works very closely with the youth and their family from
entry into custody to transition back to their home. MHS clinicians continue to provide
services to the youth and their families 6 months post-release. For youth who are placed in
group homes or foster care, when possible, MHS will continue to offer therapy to the youth,
and make appropriate referrals as needed. Youth who have turned 18 and are facing
homelessness are connected to transitional housing services.
•Home and community-based services and peer support services: MHS provides an
out-patient program, Family and Youth Alternatives which is conveniently located in a
central location across from social services and on the direct bus route. MHS provides bus
tokens to the youth to eliminate transportation problems. Each youth has the opportunity for
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post-release substance abuse counseling and the primary clinician for each youth continues
in the therapeutic milieu that has been established with the youth and their family while in
custody. MHS has a family support partner who is available to the youth and their families
to link them to any resources in the community that would benefit the youth and their family.
A peer support group, Adolescents in Motion (AIM) is available at MHS’s out-patient
location.
•Employment services: The focus with youth is on education, and successfully completing
a High School Diploma or GED and going on to Vocational School or College. However,
youth are encouraged to get summer jobs, and MHS provides them with opportunities and
resources in the community. This would include summer youth work programs, local job
postings and youth programs. Boys and Girls Club and Job Corps are invited to give
presentations at MHS programs to allow the youth to hear what opportunities are available
to them. MHS also provides, as part of the program, life-skills training opportunities
consisting of filling out applications, developing a resume and mock interviews to practice
communication skills and help develop their opportunities to secure employment.
•Transition from hospitals to community settings: The need for youth in the program to
be hospitalized for a Mental Health Crisis has been very rare. MHS staff works very hard
with youth and families to keep them stable. In the event hospitalization becomes
necessary, MHS will offer support to the youth and their families to ensure appropriate care
and referrals.
COUNTY MHBG FUNDING PLANS
Although many incarcerated individuals may be financially eligible for Medi-Cal, their
incarceration prevents Federal Medicaid payments for their health care because federal law
prohibits Federal Financial Participation (FFP) for services provided to inmates of public
institutions. The prohibition excludes individuals, including incarcerated individuals, who are
patients in medical institutions, which, under regulations, includes individuals who are patients
for at least 24 hours in a medical institution not run by the correctional system (42 USC §
1396d(a)((29)(A) & 45 CFR § 435.1009). Excluding for when the use of FFP fund is available
for eligible inmates to receive inpatient hospital or nursing home care off-site, the County plans
to continue using the MHBG funds to provide mental health services to inmates and juveniles
during their incarceration. Inmates and juveniles will be eligible for health care coverage or
apply for coverage upon their release.
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SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMSHA)
COUNTY COMMUNITY MENTAL HEALTH BLOCK GRANT (MHBG) RENEWAL
APPLICATION FY 2016-17
4 ATTEST :
5 COUNTY OF FRESNO
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By £ )1--~Cb <" ____L_.
Chairman, Board of S ervtsors
Date : ~-\\-Wtlo
BERNICE E. SEIDEL, Clerk
Board of Supervisors
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
-1 -COUNTY OF FRESNO
Fresno, CA