HomeMy WebLinkAboutAgreement A-24-098 Amendment I to Agreement with FCSS.pdf Agreement No. 24-098
1 AMENDMENT NO. 1 TO SERVICE AGREEMENT
2 This Amendment to Service Agreement ("Amendment No. 1") is dated
3 March 5, 2024 and is between Fresno County Superintendent of Schools, a Political
4 Subdivision of the State of California ("Contractor"), and the County of Fresno, a political
5 subdivision of the State of California ("County").
6 Recitals
7 A. In 2011, The Fresno County Department of Behavioral Health (DBH) and Fresno County
8 Superintendent of Schools (FCSS) began a partnership using a school wide Positive Behavioral
9 Intervention Supports (PBIS) framework for early identification and prevention of behavioral
10 and/or emotional problems of youth. During this partnership, it became evident that existing
11 mental health services were not being accessed due to geographic, cultural, and economic
12 barriers. County's DBH, through its Mental Health Services Act (MHSA) community planning
13 process, received public comments and feedback of the need to expand access to mental
14 health services. In 2016, DBH and FCSS, sharing the same interest, agreed to further expand
15 and enhance their partnership to address these needs of the community, forming the All 4 Youth
16 Program. All 4 Youth was founded on the Multi-Tiered System of Supports (MTSS) model that
17 includes outreach and engagement activities, prevention and early intervention services (PEI),
18 and clinical treatment services to integrate mental health services with school resources and
19 reduce barriers to access at school, home, and in the community.
20 B. On May 3, 2011 the County of Fresno entered into a Master Agreement with FCSS,
21 formerly Fresno County Office of Education, to provide MHSA PEI programs at school sites and
22 on February 26, 2013, the MHSA FY 2012-13 Annual Plan Update was approved which
23 included funding for the expansion of PEI programs. On June 2, 2015 the County of Fresno
24 increased the funds available to FCSS for these services in a new agreement. On May 21, 2013
25 the County entered into an agreement with various school districts to provide mental health
26 treatment services. On June 5, 2018, the County executed an agreement with FCSS to combine
27 the PEI and mental health treatment services and increase funding with the goal to have mental
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1 health services accessible in all Fresno County K-12 school sites, homes, and associated
2 communities.
3 C. On June 20, 2023, the County and the Contractor entered into County Agreement No.
4 23-273 ("Agreement"), for specialty mental health and prevention and early intervention (PEI)
5 services for youth, which superseded the previous agreement due to the California Department
6 of Health Care Services' (DHCS) implementation of California Advancing and Innovating Medi-
7 Cal (CaIAIM).
8 D. The County and the Contractor now desire to amend the Agreement to remove services
9 from the PEI component of the program due to the upcoming changes in the fiscal environment
10 and reductions in MHSA PEI funding.
11 The parties therefore agree as follows:
12 1. Prevention and Early Intervention (PEI) services, as described in Article 1 and Exhibit A-
13 2 of the Agreement, will no longer include services under the following two strategies: 1)
14 Prevention and 2) Outreach for Increasing Recognition of Early Signs of Mental Illness. This
15 component will only include services under the Early Intervention Services Strategy as
16 described in Revised Exhibit A-2.
17 2. All references to Specialty Mental Health Services (SMHS) in the Agreement shall
18 include Early Intervention (EI) services, including but not limited to the references in Article 4,
19 "Compensation, Invoices, and Payments." All payments under this Agreement will be fee for
20 service pursuant to Revised Exhibits F-1. There will no longer be cost-based reimbursement
21 under this Agreement.
22 3. That all references in the existing Agreement to Exhibit A-2 shall be deemed references
23 to Revised Exhibit A-2.
24 4. That all references in the existing Agreement to Exhibit F-1 and Exhibit F-2 shall be
25 deemed references to Revised Exhibit F-1.
26 5. That Exhibit F-2 to the Agreement is deleted in its entirety.
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1 6. Line of Section 4.2 of the Agreement located at line one (1), page ten (10) beginning
2 with word "The" and ending with word "F-Y on line three (3), page ten (10) is deleted in its
3 entirety.
4 7. Section 4.3 of the Agreement located at line four (4), page ten (10) is deleted in its
5 entirety and replaced with the following:
6 WHSA Early Intervention (EI) Services Maximum Compensation. The maximum
7 compensation payable to the contractor under this Agreement for the period of July 1, 2023
8 through June 30, 2024 for PEI services is Six Million, Seven Hundred Seventy Nine Thousand,
9 Six Hundred Fifty and No/100 Dollars ($6,779,650.00). The maximum compensation payable to
10 the Contractor under this Agreement for the period of July 1, 2024 through June 30, 2025 for El
11 services is Two Million, Forty Thousand and No/100 Dollars ($2,040,000.00)."
12 8. The paragraph in Section 4.7 of the Agreement located at line sixteen (16), page twelve
13 (12) beginning with the word "All" and ending with the number 2, at line twenty (20), page twelve
14 (12) is deleted in its entirely.
15 9. The paragraph in Section 4.9 of the Agreement located at line twenty two (22), page
16 fourteen (14) beginning with the word "PEI" and ending on page fourteen (14), line twenty-eight
17 (28) with the word "compliance" is deleted in its entirety.
18 10. The paragraph in Section 4.9 of the Agreement located at line twenty five (25), page
19 fifteen (15) beginning with the word "PEI" and ending on page sixteen (16), line one (1) with the
20 word "Agreement' is deleted in its entirety.
21 11. That Article 16 of the Agreement be deleted in its entirety.
22 12. Section 4.5 of the Agreement located at line twenty-one (21), page ten (10) is deleted in
23 its entirety and replaced with the following:
24 "Total Maximum Compensation. In no event shall the maximum contract amount for all
25 the services provided by the Contractor to County under the terms and conditions of this
26 Agreement be in excess of Seventy-Four Million, Seven Hundred Seventy Five Thousand, Six
27 Hundred Twelve and No/100 Dollars ($74,775,612.00) during the entire term of this agreement.
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1 The Contractor acknowledges that the County is a local government entity and does so
2 with notice that the County's powers are limited by the California Constitution and by State law,
3 and with notice that the Contractor may receive compensation under this Agreement only for
4 services performed according to the terms of this Agreement and while this Agreement is in
5 effect, and subject to the maximum amount payable under this section. The Contractor further
6 acknowledges that County employees have no authority to pay the Contractor except as
7 expressly provided in this Agreement."
8 13. When both parties have signed this Amendment No. 1, the Agreement, and this
9 Amendment No. 1 together constitute the Agreement.
10 14. The Contractor represents and warrants to the County that:
11 a. The Contractor is duly authorized and empowered to sign and perform its obligations
12 under this Amendment.
13 b. The individual signing this Amendment on behalf of the Contractor is duly authorized
14 to do so and his or her signature on this Amendment legally binds the Contractor to
15 the terms of this Amendment.
16 15. The parties agree that this Amendment may be executed by electronic signature as
17 provided in this section.
18 a. An "electronic signature" means any symbol or process intended by an individual
19 signing this Amendment to represent their signature, including but not limited to (1) a
20 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
21 electronically scanned and transmitted (for example by PDF document) version of an
22 original handwritten signature.
23 b. Each electronic signature affixed or attached to this Amendment (1) is deemed
24 equivalent to a valid original handwritten signature of the person signing this
25 Amendment for all purposes, including but not limited to evidentiary proof in any
26 administrative or judicial proceeding, and (2) has the same force and effect as the
27 valid original handwritten signature of that person.
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1 c. The provisions of this section satisfy the requirements of Civil Code section 1633.5,
2 subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part
3 2, Title 2.5, beginning with section 1633.1).
4 d. Each party using a digital signature represents that it has undertaken and satisfied
5 the requirements of Government Code section 16.5, subdivision (a), paragraphs (1)
6 through (5), and agrees that each other party may rely upon that representation.
7 e. This Amendment is not conditioned upon the parties conducting the transactions
8 under it by electronic means and either party may sign this Amendment with an
9 original handwritten signature.
10 16. This Amendment may be signed in counterparts, each of which is an original, and all of
11 which together constitute this Amendment.
12 17. The Agreement as amended by this Amendment No. 1 is ratified and continued. All
13 provisions of the Agreement and not amended by this Amendment No. 1 remain in full force and
14 effect. This Amendment No. 1 shall be effective July 1, 2024.
15 [SIGNATURE PAGE FOLLOWS]
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1 The parties are signing this Amendment No. 1 on the date stated in the introductory
2 clause.
3
Fresno County Superintendent of Schools COUNTY OF FRESNO
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5 Cam_
6 Dr. Mich a well-per r Nathan Magsig, Chairman of the Board of
Superinte dent Supervisors of the County of Fresno
7 1111 Van ess Avenue
Fresno, CA 93711
8 Contact/Phone: 559-265-3010 Attest:
Bernice E. Seidel
9 Clerk of the Board of Supervisors
County of Fresno, State of California
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11 ByAX . � -
Deputy
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For accounting use only:
13
Org No.: 56304329/4330
14 Account No.: 7295
Fund No.:0001
15 Subclass No.: 10000
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Revised Exhibit A-2
SCHOOL, HOME, AND COMMUNITY BASED PREVENTION AND EARLY INTERVENTION
SERVICES TO CHILDREN/YOUTH
SCOPE OF WORK
ORGANIZATION: Fresno County Superintendent of Schools
ADDRESS: 1111 Van Ness Avenue, Fresno, CA, 93712
SERVICES: El School, Home, Community Based Services— for Ages 0-22
PROGRAM NAME: All 4 Youth - El
TELEPHONE: (559) 265-3010
CONTACT PERSON: Dr. Michele Cantwell-Copher, Superintendent of Schools
I. SCHEDULE OF SERVICES:
Services are available to be provided Monday through Friday between 7:00 AM to 7:00 PM.
Public posted hours may differ are generally Monday through Friday between 7:30 AM to 4:30
PM. Operational hours flexible to meet needs of youth and families who are unavailable during
standard business hours, including scheduled appointments on Saturdays and Sundays as
needed.Access to school sites during summer as needed. Services during summer provided in-
home as needed.
II. TARGET POPULATION:
The target population to be served shall be primarily focused on Medi-Cal youth and families
who have a diagnosable mental illness (SED/SMI) with first onset of the symptoms and in
need of Specialty Mental Health Services to prevent severe deterioration/impairment.
Individual must be presenting with a diagnosable mental illness, the mental illness must be
early in its emergence/first onset (No previous treatment, No previous symptoms). Services
shall be short term (less than one year), relatively low intensity is appropriate to measurably
improve a mental health problem or concern very early in its manifestation, thereby avoiding
the need for more extensive mental health treatment or services; or to prevent a mental health
problem from getting worse. The program can serve dual covered youth (Medi-Cal and Other
Health Coverage), private insurance and uninsured that meet the criteria above but with
limitations to the length of stay. Medical necessity must be met as defined by DHCS and
further described in Exhibit B.
III. PROJECT DESCRIPTION:
A-2-1
Revised Exhibit A-2
Severity Insurance SmartCare Medi-Cal Limitations
Requirement Documentatio Claimabl
s n Required e
Severe Private Yes No 6 weeks*; A4Youth Staff
Insurance will link the youth to
Only Youth services through the
insurance plan.
Severe Medi-Cal and Yes Yes-with If eligible for services
Dual Covered denial or under private insurance,
w/ Medi-Cal 90 day services would be limited
non to 6 weeks*; A4Youth
response Staff will link the youth to
from services through the
private insurance plan. For Medi-
insurance Cal youth, one year
limitation
Severe Uninsured Yes No A4Youth staff will assist
the family to apply for
Medi-Cal/health
insurance; one year
limitation
Mild to Moderate Private Yes No limited to 6 weeks*;
Insurance A4Youth Staff will link the
Only Youth youth to services through
the insurance plan
Mild to Moderate Dual Covered Yes Yes-with If eligible for services
Youth (Medi- denial or under private insurance,
Cal and 90 day services would be limited
Private non to 6 weeks*; A4Youth
Insurance) response Staff will link the youth to
from services through the
private insurance plan. For Medi-
insurance Cal youth, one year
limitation
Mild to Moderate Medi-Cal Yes Yes If other services are
available, linkage and
care coordination should
be provided. One year
limitation
Mild to Moderate Uninsured Yes No If other services are
available, linkage and
care coordination should
A-2-2
Revised Exhibit A-2
be provided. One year
limitation
Family/Caregive Dependent on Dependent on Yes- Dependent on the youth
rs the youth the youth Depende
nt on
youth
* Can exceed the 6 week limit for care coordination purposes pending linkage to service
provider, provided Contractor notifies DBH in writing prior to the termination of the six week
intervention period and receive approval from DBH. The need shall be indicated in the clinical
documentation and data to be provided on a monthly basis to DBH. Monthly reporting shall
include the specific issues and how they are being address by the Contracted Provider.
Services shall primarily be focused on case management, linkage, individual/group
rehabilitative services. Therapy services can also be provided if clinically appropriate.
The El program shall incorporate evidence based practices (EBP) as applicable. The El
program shall ensure services are adequate in addressing the needs of the target population
including for interventions for the 0-5 population. The program shall be designed to mitigate
school failure, juvenile justice involvement and mental health crisis by addressing poor social
skills and behavior problems that are in the early stages and thus affect the child's overall
mental well-being.
Early Intervention — focuses on reducing the number of existing cases of problem behaviors,
including emotional and behavioral problems, by establishing efficient and rapid responses to
problem behavior and emotional distress. El services may include specialized group system
for students with at risk behaviors and warning signs of mental illness. This group setting will
assist children and youth with improving behavioral and social skills and increase coping
strategies at home, school and other environments while awaiting connection to specialty
mental health services. Within the El, an early identification screening system will be
implemented by a mental health clinician or a properly trained school staff to allow for early
delivery of timely intervention supports and programs to children, schools, and their families.
(See Exhibit A-3)
If a youth no longer meets criteria or is no longer clinically appropriate for El services,
program shall link the youth and ensure appropriate clinical transition.
MHSA Regulations
Since part of the funding for this El scope of work is based on MHSA PEI funding, Contractor
shall follow all requirements of a PEI program under the Mental Health Services Act (MHSA)
as defined in the current MHSA PEI Regulations.
MHSA PEI regulations state PEI programs shall be designed to utilize the following strategies:
• Be designed and implemented to help create Access and Linkage to Treatment
• Be designed, implemented, and promoted in ways that Improve Timely Access to
Mental Health Services for Individuals and/or Families from Underserved Populations
A-2-3
Revised Exhibit A-2
• Be designed, implemented, and promoted using Strategies that are Non-Stigmatizing
and Non-Discriminatory
This program will use an effective method likely to bring about intended outcomes, based on
one of the following standards, or a combination of the following standards (as defined by
current MHSA PEI regulations):
• Evidence-based practice standard
• Promising practice standard
• Community defined evidence-based practice (CDEP)
Contractor shall collect all data and fulfill all reporting requirements as specified in the
applicable MHSA El regulations related to the program type, strategies, and standards
indicated above or as indicated in MHSA regulations. Contractor will work with County to
ensure data, outcomes, and reports are included in all required MHSA reports, plans, and
updates.
Current MHSA Regulations can be found at the following website:
https://mhsoac.ca.gov
Mental Health Services Oversight & Accountability Commission (MHSOAC) - State of California
Contractor shall understand all MHSA PEI regulations to ensure they have the organizational
capacity to record, track, and report all required elements.
Early Intervention Strategy
Early Intervention Program is defined as treatment and other services and interventions,
including relapse prevention, to address and promote recovery and related functional
outcomes for a mental illness early in its emergence, including the applicable negative
outcomes listed in Welfare and Institutions Code Section 5840, subdivision (d) that may
result from untreated mental illness.
Serious mental illness or emotional disturbance with psychotic features" means, schizophrenia
spectrum and other psychotic disorders including schizophrenia, other psychotic disorders,
disorders with psychotic features, and schizotypal (personality) disorder). These disorders
include abnormalities in one or more of the following five domains: delusions, hallucinations,
disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including
catatonia), and negative symptoms.
Early Intervention is directed toward individuals and families for whom a short-duration (up to
one year), relatively low-intensity intervention is appropriate to measurably improve a mental
health problem or concern very early in its manifestation, thereby avoiding the need for more
extensive mental health treatment or services; or to prevent a mental health problem from
getting worse. Early Intervention Program services may include services to parents, caregivers,
and other family members of the person with early onset of a mental illness, as applicable.
A-2-4
Revised Exhibit A-2
Number of Persons to be Served.
Contractor shall provide services to the following number (minimum number) of persons
served (clients) per year:
Year 1: 4020 persons will be served
Year 2: 1327 Persons will be served
IV. Location of Services:
Hub locations and school satellite sites may be adjusted during the term of this agreement by
the written approval of the County's DBH Director or designee and Contractor.
Hubs Address
Selma 2020 High St., Selma, CA 93622
Fresno 2560 W Shaw Ln St. 104, Fresno, CA 93711
Eastside 4939 E Yale, Fresno, CA 93727
Clinicians and other mental health staff located at a specific site or hub may serve
students/Persons Served (clients) in other hubs/locations and other areas in the community as
needed. Students/Persons Served located in a specific location/hub may access services in
other sites/hubs as needed. Contractor shall work with County's Department of Behavioral
Health Director, or designee to ensure a smooth and efficient continuum of care for all
students/clients.
V. Cultural Responsiveness.:
A. Contractor shall provide the following as it relates to culturally responsive services:
• Contractor shall recruit and hire staff that have demonstrated experience working
with the Latino, African American, Southeast Asian, Native American, Punjabi, and
other diverse and underserved populations and have knowledge about the culture
of these targeted groups as well as other diverse communities.
• Contractor's staff shall attend annual trainings on Culturally and Linguistically
Appropriate services and care including cultural responsiveness, awareness, and
diversity as provided by Contractor. Contractor's staff shall be appropriately trained
in providing services in a culturally responsive manner.
• Contractor shall hire bilingual staff. At a minimum, Contractor shall hire staff
competent in Spanish and Hmong as these are the identified threshold languages
in Fresno County.
• Contractor shall secure the services of trained translators/interpreters as may be
necessary. Translators/interpreters may prove invaluable for languages such as
Cambodian, Russian, Arabic, Armenian, Punjabi, and others.
Translators/interpreters shall be appropriately trained in providing services in a
culturally responsive manner.
A-2-5
Revised Exhibit A-2
• Contractor shall provide services by placing importance on traditional values,
beliefs and family histories. Cultural values and traditions offer special strengths in
treating persons served and this should help guide health care messages and
wellness and recovery plans.
• Contractor shall provide services within the most relevant and meaningful cultural,
gender-sensitive, and age-appropriate context for the target population.
• Contractor shall develop plans to continually engage targeted populations.
• Contractor shall recruit and hire persons-served/family members. Regarding the
recruitment of persons-served/family members, the Contractor will be able to
consult with the County's DBH.
• Contractor shall distribute literature/informational brochures in appropriate
languages and request feedback as to how access to care could be improved for
these culturally diverse communities.
• Contractor shall conduct an annual cultural responsive self-assessment and
provide the results of said self-assessment to the County. The annual cultural
responsive self-assessment instruments shall be reviewed by the County and
revised as necessary to meet the approval of the Contractor. The Contractor can
create their own cultural responsive self-assessment tools or utilize instruments to
be provided by County.
• Contractor shall provide services throughout Fresno County in the community and
home as needed, to increase the frequency of persons-served obtaining needed
services as some children/families are reluctant to seek services at school sites.
• Contractor shall promote system of care accountability for performance outcomes
which enable children and their families to live independently, work, maintain
community supports, stay in good health, and avoid substance abuse and
incarceration.
• Contractor shall develop individual services and support plans which are flexible
and open to meet the unique needs of the targeted populations.
• Contractor shall provide family support and the creation of family partnerships
utilizing peer support for families and parenting support.
• Contractor shall establish culturally specific multidisciplinary treatment teams
responsible for assuring and providing needed services.
• Contractor shall provide parenting groups that are conducted in the preferred
language of the participant persons served/families.
• Contractor's staff will be trained to keep an open mind and maintain non-
judgmental interaction with persons-served /families.
• Contractor, when developing program services and service delivery approaches,
shall seek to hire and train staff and community stakeholders (i.e., consumers,
family members, etc.) that are providing services to consumers and families on
A-2-6
Revised Exhibit A-2
appropriate methods and approaches to delivering gender and age specific
services.
• Contractor's hiring and contracting practices shall be based on local data and
reflect the needs of the population to be served.
• Contractor shall attend the County's Diversity, Equity and Inclusion (DEI)
Committee monthly meetings, maintain its own cultural responsive oversight
committee, and develop a cultural responsive plan to address and evaluate
cultural responsive and/or DEI issues.
• County shall provide technical assistance and demographic data to Contractor in
relation to cultural responsive planning.
• Contractor shall train staff on best practice for utilizing interpreters to ensure
effective communication with monolingual consumers and families to assist in the
delivery of culturally/linguistically appropriate services.
VI. COLLABORATION:
Through the El/ site-based teams, local needs will be based on objective data. When
the data utilized by the El/teams indicates student and families may require more
intensive supports, the team will establish a coordinated seamless procedure for
comprehensive service delivery through Contractor's specialty mental health treatment
services as well as other existing local resources. School staff is sometimes the first to
identify barriers within the students' families. All too often, the social and emotional
barriers experienced by the family may affect the student's ability to access education
and quality mental health services. When the data indicates the need for intensive
mental health supports for the student and/or family, the El/ team will be able to
integrate representatives from Contractor's specialty mental health treatment services
as well as outside agencies who are working closely with the family/student to create a
person-centered action plan.
VII. COUNTY RESPONSIBILITIES:
A. County shall:
• Provide oversight, through its DBH Director, or designee, and collaborate with
Contractor and other County Departments and community agencies to help
achieve State program goals and outcomes. In addition to agreement monitoring
of program(s), oversight includes, but not limited to, coordination with the DHCS in
regard to program administration and outcomes.
• Assist the Contractor in making linkages with the total mental health system. This
will be accomplished through regularly scheduled meetings as well as formal and
informal consultation.
• Participate in evaluating the progress of the overall program and the efficiency of
collaboration with Contractor's staff and will be available to the Contractor for
ongoing consultation.
A-2-7
Revised Exhibit A-2
• Gather outcome information from Contractor throughout each term of this
Agreement. County's DBH staff shall notify the Contractor when its participation is
required. The performance outcome measurement process will not be limited to
survey instruments but will also include, as appropriate, client and staff interviews,
chart reviews, and other methods of obtaining required information.
• Assist the Contractor's efforts towards cultural and linguistic appropriate service
standards (CLAS) by providing the following to Contractor:
o Technical assistance and training regarding CLAS requirements.
o Mandatory CLAS and/or Diversity, Equity and Inclusion (DEI)
training for Contractor personnel, at minimum once per year.
o Technical assistance for translating information into County's
threshold languages (Spanish and Hmong). Translation services
and costs associated will be the responsibility of the Contractor.
VIII. Performance Outcome Measures
Contractor shall submit measurable outcomes on an annual basis, as identified in the
Departments Policy and Procedure Guide (PPG) 1.2.7 Performance Outcomes Measures,
attached hereto and referenced herein as Exhibit E. Performance outcomes measures must
be approved by the Department and satisfy all State and local mandates. The Department
will provide technical assistance and support in defining measurable outcomes. The
domains are Effectiveness, Efficiency, Access, and Satisfaction. These are defined and
listed below.
The Fresno County Department of Behavioral Health collects data about the characteristics
of the persons served and measures service delivery performance indicators in each of the
following domains: At minimum, one performance indicator will be identified for each of the
four domains listed below.
1. Effectiveness: A performance dimension that assesses the degree to which an
intervention or services have achieved the desired outcome/result/quality of care through
measuring change over time. The results achieved and outcomes observed are for
persons served.
Examples of indicators include: Persons get a job with benefits, or receive supports
needed to live in the community, increased function, activities, or participation, and
improvement of health, employment/earnings, or plan of care goal attainment.
Reduction in disciplinary interactions. Indicators - referrals, suspensions. Achievement of
treatment goals. Data sources: attendance, disciplinary data, GPA, PSC-35.
2. Efficiency: Relationship between results and resources used, such as time, money, and
staff. The demonstration of the relationship between results and the resources used to
A-2-8
Revised Exhibit A-2
achieve them. A performance dimension addressing the relationship between the
outputs/results and the resources used to deliver the service.
Examples of indicators include: Direct staff cost per person served, amount of time it
takes to achieve an outcome, gain in scores per days of service, service hours per
person achieving some positive outcome, total budget (actual cost) per person served,
length of stay and direct service hours of clinical and medical staff. Training modalities.
Penetration rates.
3. Access: Organizations' capacity to provide services of those who desire or need
services. Barriers or lack thereof for persons obtaining services. The ability of clients to
receive the right service at the right time. A performance dimension addressing the
degree to which a person needing services is able to access those services.
Examples of indicators include: Timeliness of program entry (From 1st request for service
to 1st service), ongoing wait times/wait lists, minimizing barriers to getting services, and
no-show/cancellation rates.
4. Satisfaction: Satisfaction Measures are usually orientated towards consumers, family,
staff, and stakeholders. The degree to which clients, the County and other stakeholders
are satisfied with services. A performance dimension that describes reports or ratings
from persons served about services received from an organization.
Examples of indicators include: opinion of persons served or other key stakeholders in
regards to access, process, or outcome of services received, Consumer and/or
Treatment Perception Survey. Consumer Perception Survey Pre and Post survey data
for sub components.
Data Collection
• Data collection and evaluation methods may include, but are not limited to, staff,
participant, and family interviews; and case file reviews.
• Contractor shall also conduct persons-served (consumer) satisfaction surveys to
see if there is a strong correlation of the efficacy of the evidence-based program
with specific ethnicities and languages as well as to identify gaps in meeting
cultural needs of persons-served (clients/families), if any.
• Contractor shall ensure all program clients/families participate in the Consumer
Perception Survey, formerly known as the Performance Outcomes Quality
Improvement (POQI) survey. Consumer Perception Surveys will be distributed to all
active persons-served (clients/families) to fill out and return to Contractor.
• Contractor shall maintain all data for persons served in permanent electronic case
records. Contractor shall have established policies and procedures for data
collection and confidentiality of persons served.
A-2-9
Revised Exhibit A-2
Contractor's performance will also be evaluated by County's DBH utilizing the following
performance outcomes:
Goals and Outcomes:
Individual:
• Decrease number of preschool suspensions & expulsions
• Reduction in symptoms
• Enhanced resilience
• Ensure cultural and linguistic responsive services are provided to students of
different cultures and ethnicities
• Increase in mental health awareness, early-age attachment, social support, and
academic achievement
• Student increase in attendance as well as increase in overall satisfaction of the
program for students and Parents/caregivers
• Student increase in mental well-being and self-report of positive environment
• Reduction in 5150 referrals
• Reduction in discriminatory/prejudicial activities in the school
• Reduction in suspensions, expulsions, and detentions
System/Program/Community:
• Efficient and rapid responses to behavioral health issue
• Provide emotional, and behavioral supports for youth
• Increase access to mental health services for underserved and un-served children
• Increased EBP's for youth ages birth to 5
Proposed Methods/Measures of Success:
• Records of students' progress on individualized goals
• Consumer satisfaction surveys that assess persons-served satisfaction and
improvement in presenting problems
• Quantitative analysis of identified referrals, frequency of contact, and associated
reduction in suspension/expulsion
Outcomes will be reviewed for input and are approved by the Department of Behavioral
Health Outcome Committee. The purpose is to ensure a comprehensive system wide
approach to the evaluation of programs through and effective outcome reporting process.
Through the County/Contractor Behavioral Health Collaboration mental health clinicians
will be provide services within the school and local community settings to support El
activities. Contractor staff will further collaborate with community-based organizations to
ensure that families and children ages 0-22 are linked with appropriate services to support
youth and family needs beyond those that exist within the school setting.
Reports
Contractor shall prepare an evaluation report annually and submit to the County's DBH and
make said reports available to partnering and interested local agencies and organizations
such as the project collaborators, other community agencies and mental health treatment
providers. Each annual evaluation report will include the following information:
demographics of the target population served, services provided to each participant,
A-2-10
Revised Exhibit A-2
enrollment in school, results of data analysis compared to planned process, output and
outcome measures, barriers to program implementation and measures taken to overcome
those barriers, accomplishments of program participants, lessons learned, and the final
result of any and all satisfactory survey(s).
Contractor shall be expected to comply with all Agreement monitoring and compliance
protocols, procedures, data collection methods, and reporting requirements conducted by
the County.
Additional reports/outcomes may also be requested by the County's Department of
Behavioral Health, based on among other things, identification of client/family specific needs
as well as State required reports/outcomes as needed.
Ix. MHSA Regulations Data Collection
A. The program shall collect the following demographic data:
• The following age groups:
0 0-15 (children/youth)
0 16-25 (transition age youth)
o Number of respondents who declined to answer the question
• Race by the following categories:
o American Indian or Alaska Native
o Asian
o Black or African American
o Native Hawaiian or other Pacific Islander
o White
o Other
o More than one race
o Number of respondents who declined to answer the question
• Ethnicity by the following categories:
o Hispanic or Latino as follows:
a. Caribbean
b. Central American
c. Mexican/Mexican-American/Chicano
d. Puerto Rican
e. South American
f. Other
g. Number of respondents who declined to answer the
question
o Non-Hispanic or Non-Latino as follows
a. African
b. Asian Indian/South Asian
c. Cambodian
d. Chinese
e. Eastern European
A-2-11
Revised Exhibit A-2
f. European
g. Filipino
h. Japanese
i. Korean
j. Middle Eastern
k. Vietnamese
I. Other
m. Number of respondents who declined to answer the
question
n. More than one ethnicity
o. Number of respondents who declined to answer the
question
• Primary language used listed by threshold languages for the individual
county
• Sexual orientation
o Gay or Lesbian
o Heterosexual or Straight
o Bisexual
o Questioning or unsure of sexual orientation
o Queer Another sexual orientation
o Number of respondents who declined to answer the question
• Disability, defined as a physical or mental impairment or medical condition
lasting at least six months that substantially limits a major life activity, which is
not the result of a severe mental illness
o Yes, report the number that apply in each domain of
disability(ies)
a. Communication domain separately by each of the
following:
i. Difficulty seeing
ii. Difficulty hearing, or having speech understood
iii. Other (specify)
b. Mental domain not including a mental illness
(including but not limited to a learning disability,
developmental disability, dementia)
i. Physical/mobility domain
ii. Chronic health condition (including, but not
limited to, chronic pain)
iii. Other (specify)
o Number of respondents who declined to answer the question
• Veteran status,
o Yes
o No
o Number of respondents who declined to answer the question
• Gender
o Assigned sex at birth:
A-2-12
Revised Exhibit A-2
o Male
o Female
o Number of respondents who declined to answer the question
• Current gender identity:
o Male
o Female
o Genderqueer
o Questioning or unsure of gender identity
o Another gender identity
o Number of respondents who declined to answer the question
B. Outcome reporting and the outcomes need to reduce the following negative
outcomes that may result from untreated mental illness
• School failure or dropout.
• Prolonged suffering.
• Unduplicated number of persons served per FY
A-2-13
Revised Exhibit F-1
Fresno County Department of Behavioral Health
Specialty Mental Health Services Outpatient Rates
Early Intervention Program Rates
Clinic/Site Based
(less than 50%of services are provided in the field)
Provider Rate
Provider Type Per Hour
Psychiatrist/ Contracted Psychiatrist $912.79 I
Physicians Assistant $409.38 I
Nurse Practitioner $453.91
RN $370.76
Certified Nurse Specialist $453.91
LV N $194.77
Pharmacist $436.93
Licensed Psychiatric Technician $166.97
Psychologist/Pre-licensed Psychologist $367.09 I
LPHA (MFT LCSW LPCC)/ Intern or Waivered LPHA (MFT LCSW LPCC) $237.56
Occupational Therapist $316.22
Mental Health Rehab Specialist $178.73
Peer Recovery Specialist $187.66
Other Qualified Providers - Other Designated MH staff that bill
medical $178.73
The following Supplemental/Add on service codes are contingent on the guidance and requirements stated by DHCS.
Service Unit Maximum Units that Can be Billed Rate per Unit
Interactive Complexity 15 mins per unit 1 per allowed procedure per $16.50
provider per beneficiary
Sign Language or Oral 15 mins per unit Variable $30.00
Interpretive Services
F-1-1