HomeMy WebLinkAboutAgreement A-17-531 with DHCS.pdfCommunity Mental Health Block Grant
Application (MHBG)
FY 2017-18
Presented to:
State of California
Department of Health Care Services
Dawan Utecht, Director
Department of Behavioral Health
August 2017
Agreement No. 17-531
Page 2 of 32
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
24
Page 3 of 32
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 2017-18 PLANNING ESTIMATE WORKSHEET
COUNTY: FRESNO DATE: June 23, 2017
DUNS NUMBER: _________
PROPOSED ALLOCATION $ 2,012,097
Base Allocation $ 1,593,198
Dual Diagnosis Set-Aside $ 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 2017-18. The estimate above is subject to
change based on the level of appropriation approved in the State Budget Act of 2017.
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 2017-18 budget for the provision of mental
health services for adults with serious mental illness (SMI) and children with serious emotional
disturbance (SED).
8/23/17
County Mental Health Director Date
__Dawan Utecht, Director, Fresno County Department of Behavioral Health________________
Print Name
DHCS 1750 (04/14)
Page 4 of 32
Enclosure 4
FY 2017-18 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 health peer-support programs, and mental
health primary consumer-directed programs).
Page 5 of 32
Enclosure 4
FY 2017-18 MHBG Renewal Application Page 2 of 4
(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.
(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.
Page 6 of 32
Enclosure 4
FY 2017-18 MHBG Renewal Application Page 3 of 4
(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.
(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 1975,
Section 504 of the Rehabilitation Act of 1973, Title IX of the Education
Amendment of 1972, or Title VI of the Civil Rights Act of 1964, as may be
applicable; or
Page 7 of 32
Enclosure 4
FY 2017-18 MHBG Renewal Application Page 4 of 4
(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.
________________________________ 8/23/17
Director, Department of Behavioral Health Date
Dawan Utecht Fresno
Printed Name County
Page 8 of 32
Enclosure 5
FY 2017-18 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
$187,000 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 32
Enclosure 5
FY 2017-18 MHBG Renewal Application 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, if the 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 provisions 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 provisions for children’s services and that all subrecipients shall certify
accordingly.
________________________________ 8/23/17
Director, Department of Behavioral Health Date
Dawan Utecht Fresno
Printed Name County
Page 10 of 32
State of California —Health and Human Services Agency Department of Health Care Services
Enclosure 6
2017-18
MHBG PROGRAM DATA SHEET
Complete one sheet for each MHBG funded program that supports transformation activities (as budgeted).
COUNTY: __FRESNO________________________________________________________________
PROGRAM TITLE: __Corizon Mental Health Psychiatric Services - Jail Psychiatric Services_______
PROGRAM CONTACT/TITLE: Caroline Ahlstrom LMFT Mental Health Supervisor
Phone #: __(559) 600-9354_ FAX: (559) 442-5277 E-Mail: caroline.ahlstrom@corizonhealth.com
MHBG FUNDING LEVEL: (Grant Detailed Program Budget, DHCS 1779, Line 38, Net Cost) $1,672,097____
TARGET POPULATION(S): (ESTIMATED NUMBER OF CONSUMERS TO BE SERVED IN THE YEAR WITH MHBG FUNDS)
SMI ADULT (18-59) 2424 SMI OLDER ADULT (60+) 73 SED CHILD (0-17) 0
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 32
State of California —Health and Human Services Agency Department of Health Care Services
Enclosure 6
2017-2018
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
PROGRAM CONTACT/TITLE: Susan Murdock, Program Manager
Phone #: (559) 600-4876 FAX: (559) 600-7645 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) 72
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:
Page 12 of 32
DHCS 1751 (02/15)
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: 2017 – 2018
TYPE OF GRANT: MHBG
COUNTY: FRESNO SUBMISSION DATE: August 20, 2017
FISCAL CONTACT: Kirk Hill PROGRAM CONTACT: Janell Sidney
TELEPHONE NUMBER: (559) 600-4655 TELEPHONE NUMBER: (559) 600-6831
EMAIL ADDRESS: khill@co.fresno.ca.us E-MAIL ADDRESS: jsidney@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. $ 1,672,097 $ 1,672,097
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) $ - $ 2,012,097 $ 2,012,097
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) $ - $ 2,012,097 $ 2,012,097
DHCS APPROVAL BY:
TELEPHONE:
Page 13 of 32
DATE:
DHCS 1779 (06/16)
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: 2017 – 2018
TYPE OF GRANT: MHBG
COUNTY: FRESNO SUBMISSION DATE: 8/20/17
FISCAL CONTACT: Jennifer Pardo PROGRAM CONTACT: Caroline Ahlstrom LMFT
TELEPHONE NUMBER: (559) 600-6437 TELEPHONE NUMBER: (559) 600-9354
EMAIL ADDRESS: jpardo@co.fresno.ca.us E-MAIL ADDRESS: caroline.ahlstrom@corizonhealth.com
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) $ 187,000 1.00 $ 187,000 $ 187,000
2 Mental Health Supervisor (DDX) $ 112,000 0.88 $ 98,271 $ 98,271
3 Mental Health Counselors (DDX) $ 95,668 7.02 $ 671,530 $ 671,530
4 Mental Health RNs (DDX) $ 69,888 2.19 $ 153,303 $ 153,303
5 Mental Health Specialist (DDX) $ 53,352 .88 $ 46,812 $ 46,812
6 Office Assistants (2) $ 39,000 1.75 $ 68,439 $ 68,439
7 Medical Assistants (2) $ 32,510 1.75 $ 57,050 $ 57,050
8 BENEFITS $ 256,482 $ 256,482 $ 256,482
9
10
11
12 TOTAL STAFF EXPENSES (sum lines 1 thru 11) $ 845,900 15.48 $- $ 1,538,887 $ 1,538,887
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) $ 133,210 $ 133,210
38 NET PROGRAM EXPENSES (sum lines 12 thru 37) $- $ 1,672,097 $ 1,672,097
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) $- $ 1,672,097 $ 1,672,097
DHCS APPROVAL BY:
TELEPHONE:
DATE:
DHCS 1779 (06/16)
Page 14 of 32
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: 2017 – 2018
TYPE OF GRANT: MHBG
COUNTY: FRESNO SUBMISSION DATE: August 20, 2017
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 0.34 $ 21,393 $ 21,393
2 Administrative Assistant- FFSAU $ 31,616 0.30 $ 9,485 $ 9,485
3 Clinical Supervisor - LCSW $ 75,005 0.56 $ 42,003 $ 42,003
4 Unlicensed MH Clinician - Girls $ 39,520 1.00 $ 39,520 $ 39,520
5 Unlicensed MH Clinician - Boys $ 29,640 1.00 $ 29,640 $ 29,640
6 Unlicensed MH Clinician - Boys $ 38,480 1.00 $ 38,480 $ 38,480
7 Vice President $ 89,898 0.05 $ 4,495 $ 4,495
8 Program Analyst $ 58,510 0.07 $ 4,097 $ 4,097
9 Benefits (State Unempl Ins., OASDI, Life, Health Ins., Worker’s Comp) $ 32,198 $ 32,198
10 Payroll Taxes (F.I.C.A.) $ 14,467 $ 14,467
11 $-
12 TOTAL STAFF EXPENSES (sum lines 1 thru 11) $425,598 4.32 $- $ 235,777 $ 235,777
13 Consultant / Contract Costs (Itemize):
14 Interpreter Services $ 5,000 $ 5,000
15 Equipment (Where feasible lease or rent) (Itemize):
16 Equipment Purchases < or = to $1,000 $ 355 $ 355
17 Equipment Repair/Maintenance $ 650 $ 650
18 Supplies (Itemize):
19 Postage & Freight $ 1,800 $ 1,800
20 Office Supplies $ 1,150 $ 1,150
21 Program Supplies – client education & snacks $ 5,350 $ 5,350
22 Travel -Per diem, Mileage, & Vehicle Rental/Lease
23 Staff Mileage / Vehicle Maintenance $ 525 $ 525
24 Staff Travel (Out of County) $ 2,000 $ 2,000
25 Other Expenses (Itemize):
26 Communications/Cell phones/Internet $ 42 $ 42
27 Staff Training/Registration $ 1,000 $ 1,000
28 Licenses & Taxes $ 6,200 $ 6,200
29 Prof. Fees / Acctng / Bank Charges / Other Business Svcs (new hire screen, etc.) $ 410 $ 410
30 Software Expenses $ 100 $ 100
31 Indirect Costs / Administrative Overhead $ 37,991 $ 37,991
32 Professional & General Liability Insurance $ 1,650 $ 1,650
33
34 Utilities, Janitorial, Security, and Janitorial Supplies (incurred in County's Budget) $ 10,000 $ 10,000
35 COUNTY ADMINISTRATIVE COSTS (10% MHBG) $ 30,000 $ 30,000
36 NET PROGRAM EXPENSES (sum lines 12 thru 37) $- $ 340,000 $ 340,000
37 OTHER FUNDING SOURCES: Federal Funds
38 Non-Federal Funds
39 TOTAL OTHER FUNDING SOURCES (sum lines 39 & 40) $- $- $-
40 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 32
PROGRAM NARRATIVE
County of Fresno Department of Public Health
Jail Psychiatric Services Program
By Corizon Health, Inc. - Contractor
FY 2017-2018
A. STATEMENT OF PURPOSE
Fresno County has a population of over 979,915 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 9.4%, which is the
lowest it has been in seven years yet still exceeds the State (4.8%) and National (4.3%)
average. In 2015, the Fresno-Madera Continuum of Care Point-in-Time (PIT) count found
1,745 homeless individuals in Fresno County. The County of Fresno Adult Detention
Facilities has an average daily population of 2,714 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, peop le 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.
B. 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 for FY 2017-18:
1. Serve 3,258 unique inmates between July 1, 2017 and June 30, 2018.
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 271 inmates per month.
c. Enroll 348 unique inmates in group treatment specifically for individuals with co-
occurring disorders of mental illness and substance use.
d. Provide discharge plans for 405 unique inmates.
2. Serve 792 unique inmates identified as having co-occurring disorders of mental illness
and substance use.
Page 16 of 32
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.
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 abuse, 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.
Objectives Achieved by JPS for FY 2016 – 2017:
1.About 2,773 unique inmates were provided services when 3,000 were projected to be
served in the FY 16-17 application period. This did not meet the expected outcome. An
average of 231 inmates per month were evaluated by psychiatrists working with the
program when 250 were projected. This figure is lower than predicted. As in FY 2015 -
16, 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 consi dered
to be follow-up sessions.
2.During FY 2016-2017, approximately 348 inmates were enrolled in group treatment,
which exceeded the objective of 270. All SMI patients in isolation and semi isolation
attend two different therapeutic groups each week. This increase in group participation is
a continuing result of 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, given the budget resources available.
4.About 729 unique inmates were identified as having co-occurring disorders of mental
illness and substance use, an increase over 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
Page 17 of 32
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, approximately 180
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.
Going forward into FY 2017 - 2018, 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.
C.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
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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.
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 appro priate levels of care
for those inmates diagnosed with Serious Mental Illness (Schizophrenia, Bipolar Disorder,
Major Depression with Psychotic Features 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 th e specific intervention. The
groups are available on “open-ended” enrollment. This allows for qualified individuals to
Page 19 of 32
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.
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 d iagnosis 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, modifie d, 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 disch arge plans.
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D.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.TARGET POPULATION
It is expected that the program will serve approximately 2,004 unduplicated inmates in FY
2017-2018. Of this number, 685-750 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.
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.
F.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.
Page 21 of 32
G. DESIGNATED PEER REVIEW REPRESENTATIVE
The designated peer review representative for this project is the Director, Fresno County
Department of Behavioral Health.
H. 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
Corizon/Fresno County Agreement for services and has been fully staffed for the FY 2016 -
2017. 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 as well
as the request by custody to have mental health staff on site 24 hours a day and 365 days a
year.
The current JPS contract with Fresno County expires on June 30th, 2018 and is subject to a
Request for Proposal process to select a provider(s) for services to continue effective July 1,
2018.
I. PROGRAM EVALUATION PLAN
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 abuse, 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.
J. 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.
When an inmate comes into custody the booking nurse does their best attempt to bridge any
medications the inmate may have been taking over the past 30 days. If medications are
bridged the inmate is scheduled to see the psychiatrist within 7 days.
Page 22 of 32
Inmates will receive psychiatric care while in care if they alert booking staff that they have
been taking mental health meds in the last 30 days or if they request to be seen by mental
health staff to evaluate if they need to be placed on medications. Staff reviews the medical
record to see if the inmate had previously been receiving mental health
services/medications the last time they were in custody. If the inmate had previous mental
health services the inmate would be referred to see a mental health staff.
SMI inmates that are in isolation or semi isolation are offered three visits per week with a
licensed mental health therapist. They are typically offered two mental health groups and
one individual therapy appointment. Therapists are working with custody staff in having
good communication and working on moving SMI inmates to the least restrictive housing
possible. A way to accomplish this goal is by using the “Behavior Management Plans”. The
“BMP” is a plan created by custody and mental health staff. The Plan is reviewed by the
inmate so they are aware of the goals they are working on in order to transition to a less
restrictive unit (if possible). The BMP discusses what are some of the inmate’s behaviors
and issues as to why they are placed in the restrictive housing unit. The inmate’s mental
health symptoms and ways to deescalate the inmate. These plans are discussed between
the therapist and the inmate as well as the therapist and custody staff at least biweekly.
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 they are
also able to get a 30 day prescription of their medication that can be filled at the patient own
expense.
Jail health care staff provides Discharge Planning for sentenced inmates with serious mental
health disorders every time they complete a Mental Health Evaluation. A discharge plan is
discussed with these patients focusing on the patient’s strengths, particular needs, their
main concerns when being released from custody. The discharge plan can include a
summary of intended services when they are being released from custody, 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 and include
important contacts such as probation or parole officers as well as attorneys. The discharge
plan could include connecting such inmates to community health care providers, community
social services, community-based housing, and/or appropriate services per the individual’s
need.
When SMI inmates are released during 7 and 7:30 pm mental health clinicians will complete
an exit interview with the patient. During this interview they are completing a mental status
exam making sure the inmate is appropriate to be released to the street and are not
currently a danger to themselves or others. (Therapist would speak to watch comm ander
immediately if they felt the inmate was a danger to self or others and place a 5150 on the
inmate.) The inmate is educated on where to go to get their meds that Corizon will pay for
them to get a 7 day supply in order to help them have continuity of care with having to
transition to an outside provider. Lastly, contact information is provided to the Urgent Care
Wellness Center in a pamphlet inmates receive upon discharge.
Page 23 of 32
MULTI-AGENCY ACCESS PROGRAM (MAP) POINTS
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.
Effective January 10, 2017, Fresno County entered into a Master Agreement with three
community service providers to operate Multi-Agency Access Program (MAP) Points. The
MAP Point operators provide an integrated screening process connecting individuals and
families facing challenges such as mental health, substance use disorder, physical health,
housing/homelessness, social service and other related challenges to the right resources at
the right time in the right location. This is accomplished through an established and
formalized screening process, collaboration of service providers, leveraging existing
community resources, eliminating barriers and assisting clients’ access to supportive
services. Goals of the program include less utilization of more costly crisis services, an d
minimization or avoidance of more severe outcomes such as substance use disorder,
hospitalization or incarceration. MHBG funds are not be used for the Justice MAP Point. In
critical access points such as such as the Adult Detention Facility, MAP services may
supplement the discharge planning services provided by Corizon’s Jail Psychiatric Services
program as well as continuity of care after discharge.
Page 24 of 32
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 2017-2018
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 abuse 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. 20682031186316234964874924090
500
1000
1500
2000
2500
2013 2014 2015 2016
JJC Bookings 2015 -2016
Males
Females
Page 25 of 32
B.MEASURABLE OUTCOME OBJECTIVES
CLIENT OUTCOME OBJECTIVES
During FY 2016-2017, 66 Adolescents were served. It is anticipated 72 adolescents will be served
during FY 2017-2018.
Program objectives for adolescent participants of the SAU and Post-Release Out Patient Services
(PROPS) program in FY 2017-2018 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 for each fiscal year includes provision of services by MHS July 1 through June 30.
SUBSTANCE ABUSE UNIT: IN-CUSTODY
Outcome I: Participants will be drug free six months after the
completion of in-custody program
2015-16 2016-17 Projected
2017-18
1. Number of Participants that Reached Six Month Marker 56 66 72
2. Number who are Clean During Last Three Months 50 60 66
3. Percent of Clean Participants at Six Months 90% 91% 92%
SUBSTANCE ABUSE UNIT: PROPS (POST RELEASE OUTPATIENT SERVICES)
Outcome I: Participants will be drug free at completion of
PROPS program
2015-16 2016-17 Projected
2017-18
1.Number of Participants that reached completion of
program
7 6 7
2. Number who are Clean During Last Three Months 7 6 6
3. Percent of Clean Participants at Six Months 100% 100% 86%
Outcome II: Participants will have no new convictions during
first six months after completion of PROPS program
2015-16 2016-17 Projected
2017-18
1. Number of Participants that Reached Six Month Marker 7 6 7
2. Number who have No Convictions the First Six Months 7 6 6
Outcome II: Participants will have no new convictions during
first six months after completion of in-custody program
2015-16 2016-17 Projected
2017-18
1. Number of Participants that Reached Six Month Marker 56 66 72
2. Number who have No Convictions the First Six Months 54 63 69
3. Percent of Participants with No Convictions 97% 97% 97%
Outcome III: Participants will be attending school, working, or
engaged in a vocational program six months after completion
of in-custody program
2015-16 2016-17 Projected
2017-18
1. Number of Participants that Reached Six Month Marker 56 66 72
2. Number of Adolescents in Ed. Prog/Voc. Prog./ Working 54 63 69
3. Percent of Participants Working or In Ed/Voc Program 97% 97% 97%
Page 26 of 32
3. Percent of Participants with No Convictions 100% 100% 86%
Outcome III: Participants will be attending school, working, or
engaged in a vocational program six months after completion
of PROPS program.
2015-16 2016-17 Projected
2017-18
1. Number of Participants that Reached Six Month Marker 7 6 7
2. Number who are attending school, a vocational program,
or working the First Six Months
7 6 6
3. Percent of Participants attending school, a vocational
program, or working
100% 100% 86%
MHS made progress towards our goals this year by achieving a 100% success rate with our one
year graduates in achievement of their long term outcomes (for 2 years in a row).
C.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 adolescent’s 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 a maximum of 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 abuse, 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.
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
Page 27 of 32
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 PROPS program to address the mental health and substance abuse 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, 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 abuse 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 abuse 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.
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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 abuse 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.
Transition Planning: Discharge planning truly begins at intake where all of the treatment team
works towards the successful planning to meet the Individual needs of each youth to successfully
transition back into the community. 30 days prior to release a transition meeting takes place
where each youth and their guardians are given Individualized transition meeting which
includes, referrals and a face to face meeting with Probation, the Court Schools, Our treatment
team members, collaborative who provide additional support services such as mentoring and
tutoring.
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.
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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.
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 amount of
$40,000.00 will fund County costs for utilities, janitorial, security and supplies at JJC as well as
administration of the program and MHBG.
D.CULTURAL COMPETENCY
MHS realizes that, in order to adhere to our founding values, we must tailor the way we provide
services, based on the culture and beliefs of each participant and his/her family. We also understand
that diversity includes gender identity, religious and/or cultural beliefs, family values, as well as
ethnic, linguistic, and cultural traditions. Due to the fact that minorities are overrepresented in the
criminal justice system, we also prepare for the need to have and train representative and
experienced staff. Every new participant enters our programs with a world-view, cultural
perspective, and personal beliefs that are unique. Their belief systems may be further complicated
by the manifestation of substance abuse, trauma and mental illness. In order to treat this diverse
population, staff is trained to the fullest extent in order to welcome and accept each new client,
viewing them from a “whole person” perspective. MHS provides on-going training opportunities as
well as sharing training calendar of interest and relevance for all employees. Staff that attends
trainings also bring the information back to share with their respective programs so everyone can
benefit from the material. Every MHS employee also maintains an Individual Training Plan that is
evaluated at each annual review to ensure professional development and quality skill enhancement
as it relates to cultural competency and proficiency.
MHS has encouraged programs to become more self-evaluative about their respective levels of
cultural competence and as such, MHS has adopted the following Culturally Competent Clinical
Practice Standards:
1.MHS will engage in a culturally competent community needs assessment and use the results to
plan and implement services that respond to the cultural and diversity of the population in our
service area.
2.MHS will engage in community outreach to diverse communities based on the needs
assessment.
3.MHS will collect and maintain accurate and reliable demographic data to evaluate and monitor
our CLAS impact on health equity and outcomes to inform our service delivery.
4.MHS will create a culturally and linguistically welcoming environment for the diverse
communities served.
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5.MHS will ensure that staffing at all levels are representative of the community served, both
culturally and linguistically.
6.MHS will ensure linguistic capacity and proficiency to communicate effectively with the
population served, and ensure the competence of the Individuals providing language
assistance, recognizing that untrained individuals and use of minors as interpreters shall be
avoided.
7.MHS will use interpreter services appropriately and staff will be able to demonstrate ability to
work with interpreters as needed.
8.MHS staff will demonstrate knowledge of diversity within ethnic and cultural groups in terms of
social class, assimilation, and acculturation.
9.MHS staff will demonstrate knowledge about a) specific cultural features that may be present in
various disorders; b) culture-bound syndromes; c) cultural explanations of illness; d) help
seeking behaviors, including faith-based, in diverse populations; and e) appreciation for
traditional ethnic and cultural healing practices.
10.MHS will ensure consideration of cultural factors are integrated into our clinical assessments.
11.MHS staff will take into consideration the potential bias present in clinical assessment
instruments and critically interpret findings within the appropriate cultural, linguistic, and life
experiences context of the client.
12.MHS staff will afford culture-specific consideration consistent with the cultural values and life
experiences of the client throughout the intervention and will be reflected in progress notes,
treatment planning and discharge planning.
13.MHS will ensure that Psychiatrists in our programs consider the role of cultural factors
(ethnopsychopharmacology) in providing medication services.
14.MHS will promote an environment that encourages staff to conduct self-assessment as a
learning tool.
15.MHS will ensure staff actively seeks out educational, consultative and multicultural
experiences, including a minimum of four hours of cultural competence training annually.
MHS is committed to the implementation of more culturally and linguistically competent assessments
and services that are responsive to culture, race, ethnicity, age, gender, sexual orientation, and
religious/spiritual beliefs. As such, MHS participated in the Comprehensive Continuous Integrated
System of Care (CCISC) initiative which utilizes eight practice principles that directly impact services
for the dually diagnosed (mental health and substance abuse disorders) individuals.
E.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
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Community Mental Health Services Block Grant (MHBG), involves oversight of substance abuse
staff, ensuring effective, coordinated and integrated delivery of treatment services.
F.STAFFING
Outside Provider of Service: Mental Health Systems (MHS)
Total grant FTE: 4.32
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.
G.DESIGNATED PEER REVIEW REPRESENTATIVE
The designated peer review representative for this project is the Director, Fresno County Department
of Behavioral Health.
H.IMPLEMENTATION PLAN
The co-occurring disorder treatment program is fully implemented. MHS contract with Fresno County
expires on June 30th of 2018, MHS plans to respond to the RFP for another contract period, they
have been the contracted provider for the Substance Abuse portion of the Floyd Farrow SAU since
1999.
I.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.
J.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
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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 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 HEAL TH
BLOCK GRANT (MHBG) RENEW AL
APPLICATION FY 2017-18
ATTEST:
COUNTY OF FRESNO
/L~j_ By ___________ _
Chairman , Board of Supervisors
1 2 Date: / 0 -I '1-\ I
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BERNICE E. SEIDEL , Clerk
1 6 Board of Supervisors
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1 8 By .3iu S6,,M, 6i &h o(;,
Deputy
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PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
-1 -COUNTY OF FRESNO
Fresno , CA
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APPROVED AS TO LEGAL FORM:
DANIEL C. CEDERBORG, COUNTY COUNSEL . __ _/
6 APPROVED AS TO ACCOUNTING FORM:
OSCAR J. GARCIA, C.P.A., AUDITOR-CONTROLLER/
7 TREASURER-TAX COLLECTOR
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REVIEWED AND RECOMMENDED FOR
APPROVAL:
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Dawan Utecht
15 Director, Department of Behavioral Health
: : By __ ( 0_{---+-"-t g ______ ~"--t-,,'---t __
David Pomaville
18 Director, Department of Public Health
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Fund/Subclass: 0001/10000
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Organization: 5630 ($340,000); 5620 ($1,672,097)
Account/Program: 4380
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Date: _q_,__/ _, 5'_/_I / __
COUNTY OF FRESNO
Fresno, CA