HomeMy WebLinkAbout32453Page 1 of 41
Agreement No. 15-506
Community Mental Health Block Grant
Application (MHBG)
FY 2015-16
Presented to:
State of California
Department of Health Care Services
Dawan Utecht, Director
Department of Behavioral Health
August2015
I
J
Table of Contents
1. Signed Planning Estimate Worksheet DHCS 1750 (Enclosure 1)
2. Signed Agreements (Enclosure 4)
3. Signed Certifications (Enclosure 5)
4. Completed MHBG Per Program Data Sheet DHCS 1751 (Enclosure 6)
• Jail Psychiatric Services Program
• Juvenile Justice SED Dual Diagnosis Outpatient Program
• Transitional Age Youth and First Onset-Psychosis Program
5. Federal Grant Detailed Per Program Budget DHCS 1779 (Enclosure 7)
• Summary
• Jail Psychiatric Services Program
• Juvenile Justice SED Dual Diagnosis Outpatient Program
• Transitional Age Youth and First Onset-Psychosis Program
6. Program Narrative
• Jail Psychiatric Services Program (A-G)
• Juvenile Justice SED Dual Diagnosis Outpatient Program (A-H)
• Transitional Age Youth and First Onset-Psychosis Program (A-
G)
Page 2 of41
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Page 3 of 41
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 2015-16 PLANNING ESTIMATE WORKSHEET
COUNTY: FRESNO DATE: June 8, 2015
DUNS NUMBER: 020879164
PROPOSED ALLOCATION $ 1.900.228
Base Allocation $ 1.390.811
Dual Diagnosis Set-Aside $ 418,899
First Episode Psychosis Set-Aside $ 90,518
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 2015-16. The estimate above is subject to
change based on the level of appropriation approved in the State Budget Act of 2015.
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 2015-16 budget for the provision of mental
health services for adults with serious mental illness (SMI) and children with serious emotional
disturbance (SED).
vet
Chairman, County of Fresno, Board of Su
Deborah A. Poochigian, Chairman. Board of Supervisors
Print Name
DHCS 1750 (04/14)
ATTEST:
BERNICE E. SEIDEL, Clerk
Board of Supervisors
By~ (h,j ::ho-p
Deputy
FY 2015-16 MHBG Renewal Application
Page 4 of 41
Enclosure 4
Page 1 of 4
COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT FUNDING AGREEMENTS
Public Law 106-310 (Children's Health Act of2000)
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 I 911
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).
FY 2015-16 MHBG Renewal Application
(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)(!) With respect to mental health services, the centers provide services as
follows:
(A) Services principally to individuals residing in a defined geographic
area (hereafter in the subsection referred to as a "service area").
(B) Outpatient services, including specialized outpatient services for
children, the elderly, individuals with a serious mental illness, and
residents of the service areas of the centers who have been
discharged from inpatient treatment at a mental health facility.
(C) 24-hour-a-day emergency care services.
(D) Day treatment or other partial hospitalization services, or
psychosocial rehabilitation services.
(E) Screening for patients being considered for admission to state
mental health facilities to determine the appropriateness of such
admission.
(2) The mental health services of the centers are provided, within the limits of
the capacities of the centers, to any individual residing or employed within
the service area of the center regardless of ability to pay for such services.
(3) The mental health services of the centers are available and accessible
promptly, as appropriate and in a manner which preserves human dignity and
assures continuity and high quality care.
Section 1916
(a) The County involved will not expend the grant--
(1) to provide inpatient services;
(2) to make cash payments to intended recipients of health services;
(3) to purchase or improve land, purchase, construct, or permanently improve
(other than minor remodeling) any building or other facility, or purchase
major medical equipment;
(4) to satisfy any requirement for the expenditure of non-federal funds as a
condition for the receipt of federal funds; or
(5) to provide financial assistance to any entity other than a public or
nonprofit private entity.
Page 5 of41
Enclosure 4
Page 2 of4
FY 2015-16 MHBG Renewal Application
(b) The County involved will not expend more than ten percent of the grant for
administrative expenses with respect to the grant.
Section 1946 PROHIBITIONS REGARDING RECEIPT OF FUNDS
(a) Establishment-
(1) Certain false statements and representation -A person shall not knowingly
and willfully make or cause to be made any false statement or
representation of a material fact in connection with the furnishing of items
or services for which payments may be made by a State from a grant made
to the State under Section 1911 or 1921.
(2) Concealing or failing to disclose certain events - A person with knowledge
of the occurrence of any event affecting the initial or continued right of the
person to receive any payments from a grant made to a State under Section
1911 or 1921 shall not conceal or fail to disclose any such event with an
intent fraudulently to secure such payment either in a greater amount than
is due or when no such amount is due.
(b) Criminal Penalty for Violation of Prohibition-Any person who violates any
prohibition established in subsection (a) shall for each violation be fined in
accordance with Title 18, United States Code, or imprisoned for not more than
five years, or both.
Section 1947NONDISCRIM1NATION
(a) In General -
(1) Rule of construction regarding certain civil rights laws -For the purpose
of applying the prohibitions against discrimination on the basis of age
under the Age Discrimination Act of 1975, on the basis of handicap under
Section 504 of the Rehabilitation Act of 1973, on the basis of sex under
Title IX of the Education Amendments of 1972, or on the basis of race,
color, or national origin under Title VI of the Civil Rights Act of 1964,
programs and activities funded in whole or in part with funds made
available under Section 1911 or 1921 shall be considered to be programs
and activities receiving federal financial assistance.
(2) Prohibition -No person shall on the grounds of sex (including, in the case
of a woman, on the grounds that the woman is pregnant), or on the
grounds of religion, be excluded from participation in, be denied the
benefits of, or be subjected to discrimination under, any program or
activity funded in whole or in part with funds made available under
Section 1911 or 1921.
Page 6 of 41
Enclosure 4
Page 3 of4
FY 2015-16 MHBG Renewal Application
(b) Enforcement -
(1) Referrals to Attorney General after notice: Whenever the Secretary finds
that a state, or an entity that has received a payment pursuant to Section
1911 or 1921, has failed to comply with a provision oflaw 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
(I )(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 (I )(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.
Deborah A. Poochigian
Printed Name
ATTEST:
BERNICE E. SEIDEL, Clerk
Board of Supervisors
By~~ 6j :-.bZf'
Deputy
Fresno
County
Page 7 of41
Enclosure 4
Page 4 of 4
FY 2015-16 MHBG Renewal Application
CERTIFICATIONS
CERTIFICATION REGARDING LOBBYING
Page 8 of41
Enclosure 5
Page 1 of 2
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 $1 0,000 and not more than $1 00,000 for each such failure.
SALARY CAP
The undersigned certifies that no grant funds will be used to pay an individual salary at a rate in excess of
$183,300 per year, not including benefits.
DRUG FREE WORK ENVIRONMENT
The undersigned certifies that reasonable efforts are made to maintain a drug-free work place in all
programs supported by the Federal Block Grant funds.
Page 9 of41
FY 2015-16 MHBG Renewal Application
Enclosure 5
Page 2 of2
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
according! y.
Deborah A. Poochigian
Printed Name
ATTEST:
BERNICE E. SEIDEL, Clerk
Board of Supervisors
By 3,, ISf\m &; s.b:ar
De put
Date/
Fresno
County
II
Page 10 of 41
State of California -Health and Human Services Agency Department of Health Care Services
Enclosure 6
2015-16
MHBG PROGRAM DATA SHEET
Complete one sheet for each MHBG funded program that supports transformation activities (as budgeted).
COUNTY: FRESNO
PROGRAM TITLE: CONTRACT-Jail Psychiatric Services
PROGRAM CONTACT/TITLE: Jennifer Pardo. Staff Analyst Ill. Department of Public Health
Phone#: (559) 600-7090 FAX: (559) 600-7687 E-Mail: jpardo@co.fresno.ca.us
MHBG FUNDING LEVEL: (Grant Detailed Program Budget, DHCS 1779, Line 40, Net Cost) $1 469 710
TARGET POPULATION(S): (ESTIMATED NUMBER OF CONSUMERS TO BE SERVED IN THE YEAR WITH MHBG FUNDS)
SMIADULT(18-59) 2880 SMIOLDERADULT(60+) __ _ SED CHILD (0-17) __ _
TYPES OF TRANSFORMATIONAL SERVICE(S) PROVIDED
• Check all categories that are applicable
• Please elaborate in the narrative portion of the application
II
Is MHBG funding used
to support this goal?
Transformational Categories If yes, Please check
(...J)
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 ...J
Early Mental Health Screening, Assessment, and Referral to Services are Common Practice v
Excellent Mental Health Care is Delivered and Research is Accelerated
Technology is Used to Access Mental Health Care and Information v
ADDITIONAL COMMENTS:
DHCS 1751 (02/15)
Page11 of41
State of California -Health and Human Services Agency Department of Health Care Services
Enclosure 6
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 CONTACTITITLE: Susan Murdock. Program Director
Phone#: (559) 600-4876 FAX: (559) 496-3650 E-Mail: smurdock@co.fresno.ca.us
MHBG FUNDING LEVEL: (Grant Detailed Program Budget, DHCS 1779, Line 38, Net Cost) $340 000
TARGET POPULATION(S): (ESTIMATED NUMBER OF CONSUMERS TO BE SERVED IN THE YEAR WITH MHBG FUNDS)
SMI ADULT (18-59) __ _ SMI OLDER ADULT (60+) __ _ SED CHILD (0-17) ___,_11'-'0'----
TYPES OF TRANSFORMATIONAL SERVICE(S) PROVIDED
o Check all categories that are applicable
o Please elaborate in the narrative portion of the application
Is MHBG funding used
to support this goal?
Transformational Categories If yes, Please check
<">
Americans Understand that Mental Health is Essential to Overall Health --1
Mental Health Care is Consumer and Family Driven --1
Disparities in Mental Health Services are Eliminated --1
Early Mental Health Screening, Assessment, and Referral to Services are Common Practice " Excellent Mental Health Care is Delivered and Research is Accelerated --1
Technology is Used to Access Mental Health Care and Information " ADDITIONAL COMMENTS:
DHCS 1751 (02115)
II
Page 12 of41
State of California -Health and Human Services Agency Department of Health Care Services
Enclosure 6
2015-2016
. MHBG PROGRAM DATA SHEET·
Complete one sheet for each MHBG funded program that supports transformation activities (as budgeted).
COUNTY: ~Fr~e~s~no~------------------------------------------------------
PROGRAM TITLE: Transitional Age Youth and First Onset -Psychosis
PROGRAM CONTACT/TITLE: Jeffery Avery. LMFT. Clinical Supervisor
Phone#: (559) 600-4681 FAX: (559) 600-4665 E-Mail: javery@co.fresno.ca.us
MHBG FUNDING LEVEL: (Grant Detailed Program Budget, DHCS 1779, Line 38, Net Cost) $90,518
TARGET POPULATION(S): (ESTIMATED NUMBER OF CONSUMERS TO BE SERVED IN THE YEAR WITH MHBG FUNDS)
SMI ADULT (18-59) 30-35 SMI OLDER ADULT (60+) ___ __ SED CHILD (0-17) 10-20
TYPES OF TRANSFORMATIONAL SERVICE(S) PROVIDED
• Check all categories that are applicable
• Please elaborate in the narrative portion of the application
II
Is MHBG funding used
to support this goal?
Transformational Categories If yes,
(--I)
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 v
Excellent Mental Health Care is Delivered and Research is Accelerated "
Technology is Used to Access Mental Health Care and Information "
ADDITIONAL COMMENTS.
DHCS 1751 (02115)
' '
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
State of California -Health and Human Services Agency
FEDERAL GRANT DETAILED PROGRAM BUDGET
TYPE OF GRANT: MHBG
COUNTY:
STAFFING
TITLE OF POSITION
TOTAL STAFF EXPENSES tsum lines 1 thru 11)
Consultant I Contract Costs lltemizel:
Jail Psvchiatric Svcs Proo. -Contract Corizon Health, Inc.
Page 13 of41
Department of Health Care Services
Enclosure 7
Page 1 of 4
STATE FISCAL YEAR: 2015-2016
SUBMISSION DATE: August21, 2015
PROGRAM CONTACT: Earliana Vang
TELEPHONE NUMBER: (550) 600-6835
E-MAIL ADDRESS: evang@co.fresno.ca.us
1 2 3
LAST REQUEST
ANNUAL GRANT APPROVED OR
SALARY FTE BUDGET CHANGE TOTAL
$-
$-
$-
$-
$-
$-
$-
$-
$-
$-
$-
$-
$-
$ 1,469,710
JJ SED Dual Diaanosis Proa -Contract Mental Health SYstems Inc. $ 340,000
Transitional Aae Youth and First Onset-Psvchosis
Eouioment !Where feasible lease or rentl (Itemize\:
Suoolies (itemize\:
Travel -Per diem, Mileage, & Vehicle Rental/Lease
Other Exoenses (itemize\:
COUNTY ADMINISTRATIVE COSTS 110% MHBGl
NET PROGRAM EXPENSES lsum lines 16 thru 39l
OTHER FUNDING SOURCES: Federal Funds
Non-Federal Funds
TOTAL OTHER FUNDING SOURCES lsum lines 39 & 40\
GROSS COST OF PROGRAM lsum lines 38 and 41l
DHCS 1779 (04/13)
DHCS APPROVAL BY.
TELEPHONE:
DATE:
$
$-
$-
$-
$-
$-
$-
$-
$-
$-
$-
$-
$-
$-
$-
$-
$-
$-
$-
$-
$
$-
$
90,518
1,900,228
1,900,228
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
State of California -Health and Human Services Agency
FEDERAL GRANT DETAILED PROGRAM BUDGET
I
TITLE OF POSITION
l i
I Mental Health I
I I Mental Health RN
~ I Mental Health i I t I
t Ill
i
i I
~is l CLPT)
Page 14 of41
Department of Health Care Services
Enclosure 7
Page 2 of 4
STATE FISCAL YEAR: 2015-2016
2 3
LAST -oR._n ANNUAL GRANT
0 ' •'JGET TOTAL SALARY FTE
183,300 o-:91 $ 166.457
96.300 0.65 $ 62,465
81,120 1.30 $ 105,237
50.544 0.65 $ 32,786
34,814 2.79 $ 97.103
2 1:8: 41,753
9 i.3: '
5 1.8: 92,555
I$ ' I $-,_ S-
TOTAL STAFF i (sum lines 1 thru 13) 613,627 15.31 $-$-1,322.739
~,, I Costs i
$-
$-
$-
Enuinment I ' lease or rentl i
·-5-
·-5-
I i
$-
$-
5-,_
·-Travel -Per diem, Mileage, & Vehicle Rental/Lease
$-
Other
S-,_
S-,_
S-,_
COUNTY AUMINI::; (10% $
NET I t:X i (sum lines 16 thru 40) $-$-$ 1,469.710
OTHERFUNDING "'" .I Funds
Funds
TOTAL I l SOl',""" lsum lines 41 & 42) $-$-
iCOSTOF I (sum lines 40 and 43) -$-$ 0
D ~cs '"'' lY:
TELEPHONE:
DATE:
DHCS 1779 (04/13)
State of California -Health and Human Services Agency
FEDERAL GRANT DETAILED PROGRAM BUDGET
TYPE OF GRANT: MHBG
Page 15 of41
Department of Health Care Services
Enclosure 7
Page 3 of4
STATE FISCAL YEAR: 2015-2016
COUNTY: FRESNO SUBMISSION DATE: August21, 2015
FISCAL CONTACT: Laurentius Harlan Theng PROGRAM CONTACT: Susan Murdock
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
1
2 i
5'
6
7 """ViCe
30
31
32 Staff
33
34 New
35
36
41
42
. "·
IG
TITLE OF
I, Life, Health Ins. l
l S()l IRr.Fl'; (S~ 39 & 40)
I {sum linii83ii3ri"d 41)
DHCS 1779 (04/13)
ANNUAL
SA ~RY
~
65,416
46,696
24,960
38,480
$ 83,990
$ 58,760
1 2 3
GRANT AP~~0Eo OR lT
FTE c==i="'B:;;;U~OG;:;:E~T~=i==C;:;:H,::,A,;;;N;;;;G::;;E=?7=,;,;TO~T~A§L~ce=
0.3~5------~-------+~$ ___ ~22.,0~22
0.30 $ 8.861
0.56 36,633
1.0( 46.696
1 0( 24,960
1 0( 38.480
0.05 4,200
o.io 5,876
36.326
14,361
<Fees
' RUClOei)
$-
~
B-
$-
$-
$-
r r.l'; APPROVAL BY:
TELEPHONE:
DATE:
S3o,ooo
$-
State of California -Health and Human Services Agency
FEDERAL GRANT DETAILED PROGRAM BUDGET
TYPE OF GRANT: MHBG
TITLE OF
Page 16 of41
Department of Health Care Services
Enclosure 7
Page 4 of4
STATE FISCAL YEAR: 2015-2016
ANNUAL GRANT
SALARY FTE
1
LAST
APPROVED
m•~~~T
2 3
TOTAL
1 ~-----------------------------+------+-----~--------}-------+----------2~-----------------------------+------+-----~--------}-------+----------3~--------------------------4-----~-----+-------+------~---------4
5 TOTAL STAFF ; (sum lines 1 thru 11) $-s::-$-$-
6 C 1/C !Cos!sll
7 Felton Ins!· I Tho. (8 Staff@ 1.500 e l + 2 1 I tnJ $2 !iOO '"'' $ 17,000
8 i , Trainina for i $-
1~~-----------------------------+------+-----~--------}-------4~::--------
11e~~~~$-~ 12 "~"•~-~~• ' lease or rent) i
13 Droo In Center: Dell Venue 11 Pro ; (6@ 'l:a~R 4'2 ea) $ 5,631
14 Droo In Center: Dell" : 9020 Ultra Small Form ; (2@ ¢~a" R4 ea\ 1.390
15 Droo In Center: HP Pr05oo coTOrMFPM57odn I 999
16 DrOPTriCenter: RCA 46" LED46C45RQ lED HDTV Flat Screen TV 314
17 Dr~~ I~ Center:'"· .. ~. -•-1 DLP 878
18 Dr0Pii1Center: Smart I'"" R~v DVD Disc Plaver I 95
19 T1ron n C:enter: Furniture & Fu (book , chairs, r tables & chairs. etc\ 10.000
20 [lroo n Center: :cables (6@ $300 ea), • ($150), & HDMI · cable($150) $ 2,050
21 I i I
22 (~o~ (oaoer, oends. toner, etc) ~
23 nmnTi1 Center: Snack I 1 ,500
24 Droo In Center: i I I ' books, 'texts.etc.f ,000
25 DrOPTriCenter: Art • "'"""l;oo I , oaoer. chalk. oaint. etc.) ,500
26 Droo In Center: I ; for daily livinQ skills, job :etC: 2( 000
27~------------------------------------------~--------r-------~'-~-------
28 Travel -Per diem, Mileage, & Vehicle Rental/Lease
29
30 Other
31 DrOPTriCenter: Trios (2 alley trips@ $675 ea)
32 Droo In Center: Trips (50 clients @ $9 ea for 4 movie""iriMl
33 Droo In Center: Board Games (10@ $25 ea\
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DATE:
DHCS 1779 (04/13)
PROGRAM NARRATIVE
County of Fresno Department of Public Health
Jail Psychiatric Services Program
By Corizon Health, Inc. -Contractor
FY 2015-2016
A. STATEMENT OF PURPOSE
Page 17 of 41
Fresno County has a population of over 955,272 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 1 0.2%, which is the lowest it has been
in seven years yet still exceeds the State (7%) and National (5.6%) average. The homeless
population in Fresno County is estimated to be 16,000 people. The County of Fresno Adult
Detention Facilities has an average daily population of 2,646 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 abuse problem.
" ... studies indicate that rates of serious mental illness are at least 3 to 4 times higher than the
rates of serious mental illness in the general population [in jails]. Many of the mentally ill
inmates are in jail because of their symptoms. When incarcerated, people with untreated
mental illness are especially vulnerable to assault or other forms of intimidation by predatory
inmates." (Criminal Justice/Mental Health Consensus Report 2002). Also, the County jail
environment can itself exacerbate the symptoms of the mentally ill, which increases the
likelihood of further impairment of functioning as well as physical risk.
The need for a jail-based mental health program is evident. Jail Psychiatric Services (JPS)
provides a 24-hour, 7-day a week mental health service delivery system. The program is
designed to identify and stabilize mentally ill inmates, and to identify and stabilize those inmates
that have co-occurring mental illness and substance abuse problems.
MEASURABLE OUTCOME OBJECTIVES
The mission of the Jail Psychiatric Services program is to provide a jail-based 24-hour, 7 -day a
week mental health program in the County of Fresno Adult Detention Facilities.
Objectives:
1. Serve 2,880 unique inmates between July 1, 2015 and June 30,2016.
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 360 inmates per month.
c. Enroll 270 unique inmates in group treatment specifically for individuals with co-
occurring disorders of mental illness and substance abuse.
2. Serve 662 unique inmates identified as having co-occurring disorders of mental illness
and substance abuse.
a. JPS will document the number of inmates that will receive dual diagnosis
treatment.
.
l
Page 18 of41
3. Work with other county programs to link 30 inmates to intensive case management
follow up programs either through the Behavioral Health Court in Fresno County, or to
treatment programs for dual diagnosis.
Objectives Achieved by JPS for FY 2014-2015
1. About 3,039 unique inmates were provided services when 3,000 was projected to be
served in the application. This exceeded the expected outcome. An average of 377
inmates per month was evaluated by psychiatrists working with the program when 100
were projected. This figure is significantly higher than predicted over the previous year.
It appears this is due to the effectiveness of service delivery, reduction in waiting time for
services, and proactively identifying individuals in need of mental health services.
2. During FY 2014-2015 no inmates were enrolled in group treatment during the year,
which was a significant decrease compared to the objective of 250. These numbers
were seen to be lower than the previous year because of staffing variability in initial
adjustment period of Corizon in the facility as the new mental health and medical
provider.
3. Future year's objectives take into account the increasing population in the jail, despite
the continuing pattern of releases due to overcrowding. Additional effort will be made in
the coming year to reach all objectives, anticipating that budget resources are unlikely to
improve before 2016.
4. About 670 unique inmates were identified as having co-occurring disorders of mental
illness and substance abuse, a decrease in the objective of 725.
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 necessitating closure of programs, outsourcing of
inpatient capacity, and restriction of services to a target population carrying only those
diagnoses meeting the criteria of Serious Mental Illness. At the same time, jail
overcrowding prompted a move towards cite and release of arrestees with non-violent
crimes, putting many of the dual diagnosed individuals with lesser charges back out into
the community at booking. These factors contributed to the reduction of appropriate
placements into treatment programs directly from the jail. However, about 30 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 2015-2016, it is clear that the stability and availability of residential dual
diagnosis programs is likely to be diminished. 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.
Page 19 of41
B. PROGRAM DESCRIPTION
The Jail Psychiatric Services program provides a variety of treatment options in the jail setting
based on community standards for outpatient services. These include the following:
• Evaluation and assessment, including dual diagnosis
• 24-hour crisis intervention
• Medication management, including management of dual diagnosis issues
• Referral for acute psychiatric hospital care
• Consultation with correctional officers to determine appropriate housing
• Monitoring of the safety and isolation cells for the mentally impaired inmates
• In-house dual diagnosis program and coordination with the Behavioral Health Court
to facilitate alternatives to incarceration.
• Group treatment specifically designed to address dual diagnosis issues
• Referrals from Behavioral Health Court. Staff representation in BHC Monthly
meetings to assist with continuity of care.
• Development and implementation of behavioral plans to change problematic
behaviors
All inmates are initially screened at booking by medical staff to determine their immediate
mental health needs. Many of the inmates referred to Jail Psychiatric Services come from this
initial screening at booking. However, inmates can refer themselves directly. Other referral
sources are family, courts, and correctional officers.
The modified in-house dual diagnosed program provides treatment through the multiple
activities involving identification, assessment, medication management, dual diagnosis groups,
and linkage to other resources when possible. The treatment is coordinated by JPS staff
through a team approach. The team meets daily to provide coordination and consistency in
treatment which are highly recommended in dealing with dual diagnosis issues. By maintaining
a coordination of care through the team approach, treatment goals can be identified and
achieved efficiently.
JPS continues the policy and procedure for providing a contact line to be exclusively used by
the community to provide information pertaining to the care and welfare of inmates. In 2006,
members of the Mental Health Board of Fresno County identified a need for family members to
be able to relate information to JPS staff regarding incarcerated family members and JPS
responded to this need by installing two contact lines (one telephone and one facsimile) for this
purpose. The use of this line has expanded over the years, and attorneys now leave messages
of concern regarding health of their clients and requests for assistance with possible dual
diagnosis issues.
The need for continued identification and linkage to alternatives to incarceration is evident.
Once discharged, detainees can be referred directly to the Department of Behavioral Health's
outpatient treatment programs or can be placed in other appropriate levels of care for those
inmates diagnosed with Serious Mental Illness (Schizophrenia, Bipolar Disorder, Major
Depression with Psychotic Features, Post-Traumatic Stress Disorder and Schizoaffective
Disorder). JPS has advocated for inmates who have participated in the program to attend dual-
diagnosis programs outside of the jail (such as West Care in the Fresno area) once they are
discharged. Many of these programs are struggling with budget issues, and are no longer
available as resources. Identification of new program resources is a continuing effort.
Page 20 of41
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 second full year of operation. A grant funded study of outcomes
regarding the court participants continues this year, in order to assess the impact of
participation in the court by the referred inmate patients. Initial data for 2011 -2012 is not yet
available, but may have useful information for future direction and planning of program
operations.
Clients at the jail receive individualized treatment by a multi-disciplinary team based on the
existence of co-occurring disorders and the need for simultaneous treatment of the symptoms
presented (Integrated Treatment Model). The management of clients through the program
includes the following processes: 1) referral, 2) engagement of client, 3) assessment procedure,
4) psychiatrist evaluation, 5) case manager assignment (clinician or nursing staff), 6)
completion of paperwork, and 7) follow-up.
Fresno County began group treatment programs in November of 2008 for the dually
diagnosed inmates. The target population is those individuals incarcerated that have a
history of/or can be diagnosed with co-occurring disorders. The groups consist of up to
15 individuals who have been screened and meet the admissions criteria to participate in
the group sessions.
The groups are co-facilitated by JPS staff who have knowledge of co-occurring disorders
and who are able to effectively provide the specific intervention. The groups are
available on "open-ended" enrollment. This allows for qualified individuals to receive the
services without a lengthy delay. Length of stay in the Fresno County jail is quite
variable, depending upon numerous factors such as level of offense, bail amount,
releases due to overcrowding, and other factors beyond the control or prediction of JPS.
Therefore, it is important to provide prompt access to treatment for this fluid population.
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
Page 21 of41
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.
Psvchiatrist 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,
multidisciplinary consultation, and review of information from custody. Based on the results of
evaluation, the inmate with dual-diagnosis issues may be started and/or maintained on
appropriate medications and follow up support from mental health staff and psychiatric staff.
Options range from ongoing supportive contacts to medication support, to placement in safety
cell or higher level of care outside the jail, depending upon the needs of the inmate. Inmates
who present at the jail with existing medication treatment programs are evaluated as a priority
by the psychiatrists, and existing medication programs may be continued, modified, or
discontinued as determined by the psychiatrists.
Case Manager Assignment and Follow-up
Consumers who are willing to be engaged into treatment are assigned a case manager who is
responsible for providing follow up contacts within the jail setting. Depending upon the
treatment needs, inmates may be continued in follow-up with a psychiatrist for
monitoring/adjustment of medications and with a staff clinician or mental health worker for
supportive contacts, including development and implementation of discharge plans.
C. TARGET POPULATION
It is expected that the program will serve approximately 2,600-3,000 unduplicated inmates in FY
2015-2016. Of this number, 600-700 will be provided services to address dual-diagnosis
issues. 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.
Page 22 of41
All services will be inclusive of cultural and language capabilities to engage and maintain
treatment populations that have been historically underserved. JPS staffing includes bilingual
staff, providing linguistic and culturally competent services in Spanish and Hmong. The
program has interpreter resources available to insure that language barriers are addressed in
assessment and treatment. Every effort will be made to provide psycho-education and
individual treatment programming options with staff that are competent in the culture and
language of the treatment population.
D. STAFFING
Outside Provider of Service-Corizon Health, Inc.
Licensed Psychiatrist, Licensed Mental Health Worker Supervisor, Licensed Mental Health RN,
Unlicensed Mental Health Specialist, Office Assistant Ill, Medical Assistant, Licensed
Professional Counselor, Psychiatric Aide/Associate (LPT).
CULTURAL COMPETENCY
Fresno County is a multicultural community. Threshold languages are English, Spanish, Lao,
Cambodian, and Hmong. Historically, there has been a consistent request and demonstrated
need for dual diagnosis services for Spanish monolingual consumers. The design of JPS
includes multicultural concepts. Threshold language services will be available through
multicultural staff and interpreters.
Consumers entering JPS will be assessed by licensed mental health staff. Part of that
assessment will include focus on natural support systems and cultural strengths that can be
interwoven with treatment. Ongoing assessment of individuals will focus on functioning in the
program and relating to the ethnic and social support systems appropriate for recovery.
Title VI of the Civil Rights Act of 1964 clearly specifies the efforts required for providing
culturally and linguistically appropriate services for consumers accessing health systems such
as JPS. Providing language assistance or having program staff with language capability,
involving natural support systems, maintaining a cultural focus during the assessment and
treatment planning and carefully evaluating each consumer's cultural strengths will go hand in
hand with outreach to the culturally diverse target populations. The objectives of Title 15 of the
California Code of Regulations also indicate that those in a detention facility should be afforded
the same opportunity for treatment as those not incarcerated, to the extent that resources allow.
E. DESIGNATED PEER REVIEW REPRESENTATIVE
The designated peer review representative for this project is the Director, Fresno County
Department of Public Health.
F. IMPLEMENTATION PLAN
The Jail Psychiatric Services dual diagnosis program was completely staffed and fully
implemented in January 2002. As of June 23, 2014 staffing levels were changed to meet
Corizon/Fresno County Agreement for services and has been fully staffed for the FY 2014-
2015. A plan to increase mental health staffing levels to address SMI population by 5.3 FTE as
Page 23 of41
of August 1, 2015 has been approved by Fresno County Board of Supervisors as of July 14,
2015. Estimated completion of hiring process to fill these vacancies is October 2015.
G. PROGRAM EVALUATION
JPS monitors program operations and goals on an ongoing basis. Program objectives are
monitored by assigned staff. Consumer 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 NARRATIVE
County of Fresno 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 2015-2016
A. STATEMENT OF PURPOSE
Page 24 of41
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 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 180 day 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. Each
adolescent and their family are transitioned 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.
I
I
I ,.
Page 25 of41
---------·------------~
3000
2500
2000
1500 !1\1 Male Bookings
1000 L!l Female Bookings
500
0
2011 2012 2013 2014
*Source: Fresno County Probation Department Annual Report 2013-2014
B. PROGRAM DESCRIPTION
Intensive services by Mental Health Systems, Inc. (MHS) targets adolescents who are in-
custody at the County's Juvenile Justice Campus (JJC). Post-released services are also
provided upon completion of the in-custody program as adolescents transition back into the
community. There is capacity at the JJC to serve 40 in-custody adolescents at any given time.
FLOYD FARROW SUBSTANCE ABUSE UNIT (SAUl
In-custody treatment consists of dual diagnosis services for thirty (30) males and ten (1 0)
females, a distribution reflective of the target population, in a full scope gender-responsive
therapeutic community treatment model. In-custody program duration is six (6) months.
Progress and completion of the program is based upon a level and phase system.
While in the SAU a range of services is provided to every adolescent and family incorporating
the following elements:
1. Completion of a comprehensive mental health assessment by a clinician upon intake. If
needed, referrals for psychotropic medication evaluation are made to Corizon Staff at the
Fresno County Juvenile Justice Campus. Corizon is responsible for evaluation, prescription,
administration, and oversight of psychotropic medications.
2. Treatment services that are centered on a multidisciplinary treatment team of mental health
and substance 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.
Page 26 of41
4. Curriculum is adjusted to the adolescent's developmental needs and to meet educational,
cultural, and gender specific requirements. Certain values and structures must be
maintained to support the effect of group-based programs, but each treatment plan is
individualized.
5. Integration of extracurricular and therapeutic activities is offered to stimulate interest while
supporting the message that sobriety can be fun and meaningful. These activities may
include talent shows, holiday celebrations, after-care field trips, family potlucks and
barbeques as a means of engaging clients and families. Adolescents in the SAU and their
families experience an atmosphere of acceptance and trust, demonstrated by the number of
families involved in the program.
6. Commitment to teams of mental health clinicians and MHS substance abuse counselors
with a low client-to-staff ratio and a wide range of diversity and expertise to improve client
outcomes, including staff gender and ethnic/cultural diversity, is consistently demonstrated
in staffing. Further, MHS requires that all staff participate in ongoing cultural competence
staff training.
7. MHS provides a Post-Release Outpatient Services program (PROPS) to address the mental
health and substance 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
Ml, as a means of engaging and motivating adolescents and families. Ml 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 Ml counseling style, including interviewing and brief intervention techniques,
Page 27 of41
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.
• 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.
Page 28 of41
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 begin the second phase process of recovery. The six-month post-release
program provides intensive out-patient services. The continuity of service allows clinicians to
develop a consistent and longer term therapeutic relationship with the adolescents and their
family (6 months in-custody, 6 months post-release). This consistent and stable relationship
between client and clinician assists in maintaining stability, family participation and treatment
compliance as the client reintegrates into their community and peer culture.
The PROPS program provides the following services:
• Intensive substance abuse treatment services
• Individual and family therapy and mental health services as needed;
• Crisis intervention;
• Case management provided by the multidisciplinary team;
• Process and family groups, ancillary referrals, educational/vocational assistance, Life
Skills curriculum, coordination of clean and sober activities, educational forums, and
family centered activities;
• Information and referral to community-based 12-Step programs;
• Opportunities for community service work; and
• Clean and Sober social and recreational activities.
C. TARGET POPULATION
The target populations are adolescents diagnosed as severely emotionally disturbed (SED) who
have a co-occurring substance abuse diagnosis, and are either in-custody at the Juvenile
Justice Campus or are in the Post-Release Outpatient services component. Mental health staff
works very closely with the substance abuse counselors. Each juvenile is assigned to a team
consisting of both clinician and a substance abuse counselor. This team is responsible for
providing services to the juvenile and his/her family throughout treatment. The assigned team
follows the family through all phases of treatment, including PROPS, and is available as needed
during periods of crisis, instability and challenges. Part of the Clinical Supervisor's time, not
funded by SAMHSA Community Mental Health Services Block Grant (MHBG), involves
oversight of substance abuse staff, ensuring effective, coordinated and integrated delivery of
treatment services.
D. STAFFING CHART
Outside Provider of Service -MHS
SAMHSA MHBG FY 2015-16 funds 100% of the contracted services which are provided by a
community provider, MHS. The amount of $340,000.00 will fund salaries and benefits and
Page 29 of41
operating expenses associated with the provision of the co-occurring disorder program provided
by MHS.
Total grant FTE 3.89
Vice President is responsible for overall oversight.
Program Manager reports to the Vice President and is responsible for program oversight.
Program Analyst is responsible for financial, support services, project coordination, and
program's budget maintenance.
Administrative Assistant is responsible for administrative and clerical support to the clinical
team.
Clinical Supervisor reports to the Program Manager and is responsible for the clinical
supervision of the three unlicensed clinicians and four mental health interns (this program has
become a teaching program, providing the opportunity for several Master's interns MSW and
MFT from Fresno State University, University of Phoenix, National University, and University of
Southern California to complete their internship). In addition, the Clinical Supervisor manages a
case load of five adolescents; assists in monitoring SAMHSA MHBG funded positions, data
collection and evaluation, treatment planning, assessments, crisis, collaboration, and provides
hands-on supervision.
Unlicensed clinicians report to the Clinical Supervisor and each carries a case load of 10-15
adolescents (in-custody) and up to 10 adolescents in PROPS (post-release). Each provides
case management, aftercare, home visits and linkages necessary for community transition.
E. DESIGNATED PEER REVIEW REPRESENTATIVE
The designated peer review representative for this project is the Director, Fresno County
Department of Behavioral Health.
F. IMPLEMENTATION PLAN
The co-occurring disorder treatment program is fully implemented.
G. PROGRAM EVALUATION PLAN
Monthly service reports include the number of minors served and services provided. Monthly
outcome reports delineate number of minors' outcome while completing the program. Program
staff continues to identify and resolve problems as encountered by the program through
communication and collaboration internally, as well as with community partners.
CLIENT OUTCOME OBJECTIVES
During FY 2014-2015, 98 Adolescents had been served. It is anticipated 110 adolescents will
be served during FY 2015-2016.
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Program objectives for adolescent participants of the SAU and PROPS program in FY 2014-
2015 are:
• Participants will be drug free six months after completion of in-custody program;
• Participants will have no new convictions during first six months after completion of in-
custody program; and
• Participants will be attending school, working, or engaged in a vocational program six
months after completion of in-custody program.
PROGRAM DATA
Data includes provision of services by MHS July 1, 2013 through May 30, 2015.
SUBSTANCE ABUSE UNIT: IN-CUSTODY
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1
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1
1. Number of Participants that Reached Six Month
Marker
63 67 80
2. Number who are Clean During Last Three Months
3. Percent of Clean Participants at Six Months
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working ,lor' erigaged:iri ·al(ocatioba l~prog t;:itrtOsiX.:i'nqn{hs i' ···~ff~r'cor:n··letforilot•iiiJ:.i\bstcia···:':':r~ i'am:~::,:m•::c·.·,·,.::,,.::•':':.:•:~'\:::
1. Number of Participants that Reached Six Month
Marker
58
92%
2. Number of Adolescents in Ed. ProgramNoc. 58
Pro ./Workin
54 68
80% 85%
63 71
94% 88%
Page 31 of41
SUBSTANCE ABUSE UNIT: PROPS !POST RELEASE OUTPATIENT SERVICES!
Marker
2. Number who have No Convictions the First Six 1
Months
No Convictions 83% 78% 82%
Marker
2. Number who are attending school, a vocational 16 13 13
school, a
H. AFFORDABLE CARE ACT IMPLEMENTATION
The ACA involves four key strategies: Insurance Reform, Coverage Expansion, Delivery
System Redesign and Payment Reform. The components/obstacles of the ACA which are
having the largest administrative impact on the Department of Behavioral Health (DBH) are
Coverage Expansion, Delivery System Redesign and Payment Reform. As the ACA resulted in
coverage expansion through the expansion of Medi-Cal, the growth of coverage was further
impacted by the formation of the Health Insurance Exchange known as "Covered California",
which provides credits and subsidies to fund insurance premiums for individuals with incomes
up to 400% of the federal poverty level. The majority of these individuals, who became newly
eligible for either Medi-Cal or Covered California, had previously been identified as "indigent" or
"medically indigent" by the County. For DBH, these clients were previously assessed under the
Uniform Method for Determining Ability to Pay (UMDAP). DBH staff is currently in the process
of identifying those clients who were previously seen as an "indigent" or "UMDAP" and is
working to identify what coverage, if any, they are newly eligible for and to ensure that they
complete an application for enrollment.
IMPLEMENTATIONS AS PART OF THESE EXPANDED ESSENTIAL BENEFITS:
• DBH worked with local Managed Care Plans (MCP), including Anthem Blue Cross and
CaiViva/Healthnet, to develop Memoranda of Understanding (MOUs) in 2014 to ensure
Page 32 of41
beneficiary access to appropriate mental health treatment. As some of the services now
provided through the MCPs were previously only available through the County Mental
Health Plan (MHP), much administrative work is being done to identify a screening tool for
determining level of impairment, along with refining processes of how care will be
communicated and coordinated between the MCP and the County MHP.
• DBH will develop an administrative oversight team and a multi-disciplinary clinical team to
manage the care coordination process on an ongoing basis, which will meet routinely to
address any concerns and to ensure access to appropriate treatments are available.
• In order to redesign the system of care effectively and efficiently, DBH will collect better data
and have improved systems of data analysis to best guide our design and decision-making
capabilities. DBH has piloted a Primary Care Integration model over the last several
months, partnering with the Ambulatory Clinics at Community Regional Medical Center. This
pilot will be expanded to bring primary care to the mental health setting. These efforts will
require significantly improved decision support activities to ensure the County is complying
with the requirements of the ACA, that DBH is only providing care that is within the County's
obligation, and that DBH is coordinating care to ensure access and meeting required
outcome measurements.
• Another component impacting the new administrative responsibilities is Payment Reform.
Newly eligible Medi-Cal enrollees will have their care 100% funded by the federal
government. While the billing process will be unchanged, the reconciliation process between
the County's different funding sources will require increased work for DBH staff. DBH will be
required to reconcile/account for the new and old Medi-Cal populations differently to ensure
the accounting for the appropriate and distinct funding streams.
• Additionally, the need to ensure that medical necessity criteria are met, including proper
application of the screening criteria, will be increased and will place an increased focus on
both the authorization and utilization review activities. There may be some services that
DBH currently provides that will now be billed to the MCP; these services will require a
separate accounting, as well, for cost report purposes. In sum, DBH will put new systems in
place and enhance existing processes to ensure that the County only funds services within
our obligation and are paid appropriately/adequately within the funding streams available.
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 § 435.1 009). 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.
PROGRAM NARRATIVE
County of Fresno Department of Behavioral Health (DBH)
Children's Mental Health Division
Transitional Age Youth and First Onset-Psychosis Program
FY 2015-2016
A. STATEMENT OF PURPOSE
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In servicing clients of Fresno County's existing program for first episode psychosis (FEP),
Transitional Age Youth (TAY) and First Onset-Psychosis (FOT), Fresno County Department
of Behavioral Health will employ a community-based, multi-dimensional team approach that
incorporates the evidence-based practices of Cognitive Behavioral Therapy-Psychosis
(CBTp) and Transition to Independence Process (TIP) model to further unify current program
components of client-centered, strengths-based case management, psychiatry, therapy, family
involvement, and supportive education/employment into the cohesive framework of a
Coordinated Specialty Care (CSC) model and elevate the quality of care through the use of a
high-fidelity model. These services are partially funded through Mental Health Services Act
(MHSA) Prevention and Early Intervention (PEl) funds and are aligned with the MHSA guiding
principles of community collaboration, cultural competence, clienUfamily-driven system of care,
a focus on well ness and recovery, and the provision of an integrated service experience. The
Department shall ensure that these values and principles are acquired and maintained by
service providers through the provision of ongoing and follow-up fidelity training and education
based upon annual program review.
B. PROGRAM DESCRIPTION
Fresno County has expanded crisis stabilization center services to serve both youth and
adolescents (in addition to Adult Services) as well as opened a state-licensed 16-bed child-
adolescent psychiatric health facility (PHF) for youth ages 7-18 on the main mental health
campus that will fill a void in inpatient psychiatric services for youth placement within the
county. A seamless system of care targeting early intervention for our transitioned age youth
experiencing psychosis will be created by partnering closely with these programs. The
enhanced program will be able to interface with the child-adolescent crisis stabilization center
and Youth PHF, preventing hospitalization when appropriate, providing immediate same day
access to outpatient follow-up care, and providing seamless step-down from hospitalization.
The FEP Set-aside funding allocation available to Fresno County will continue to be used to
launch professional training and education to the TAY/FOT clinical team and program staff
currently serving clients in the target population. Three evidence-based models trainings were
funded in FY 2014-15: CBTp for case mangers (Felton Institute), the TIP model (STARS
Behavioral Health Group-STARS Training Academy), and the CSC model (Lisa Dixon, MD
MPH, Professor of Psychiatry, Columbia University Medical Center). In FY 2015-16, program
staff will participate in CBTp training targeted towards clinicians (Felton Institute).
In addition, funding will also be used to support the development of a TAY/FOT Drop In Center.
A Drop In Center allows the program to serve more people and encourage early identification.
Evidenced based practices such as the Well ness and Recovery model, Motivational
Interviewing, CBTp, and the TIP model all support a treatment approach from the client's
perspective and utilize their life experiences, instances of success and strengths. These models
propose that programs and interventions be modeled on what was learned from clients. Fresno
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County Department of Behavioral Health learned from clients that a Drop In Center would be a
beneficial resource to them, as evidenced by their organic, informal attempts to create a Drop In
Center for themselves in the lobby. Through observation, informal interviews, and weekly case
consultation, factors below were identified as necessary for clients to overcome stigma, to
engage in treatment, and to increase participation in services. A Drop In Center supports these
needs and encourages growth and development toward increasing the interdependence and
independence necessary for wellness and recovery.
Sense of Belonging:
Clients have clearly identified that they do not have a sense of belonging and that they are often
treated as outcasts by their peers and in society in general. Clients have repeatedly expressed
the need to have a place to gather together with statements such as, "coming together in this
group is the first time that I have had friends", "the people that come to this center are like me
and we can relate to one another", "I now recognize that I am not the only one who has mental
health challenges", and "I want more chances to be with others and do things together with
people my own age". They also expressed the need to belong by informally congregating in the
lobby together on non-appointment days as well as even arriving hours early on appointment
days to interact with both peers and staff.
Needed Structure:
The vast majority of program clients have very little structure provided in their homes due to
lack of parental support: parents that are too overwhelmed to provide the needed support,
parent/caregiver being absent, or a lack of support due to ongoing chaos in the home. As a
result of the lack of support and structure, clients have not learned needed skills, reached
developmental milestones, nor have the self-confidence to assert them to move forward in
taking on adult responsibilities. A lack of support and consequently arrested development often
lead to clients living rather unproductive lives. It is not uncommon for clients to spend a vast
majority of their time playing video games all through the night and then sleeping most of the
day. Other unproductive time can include doing much of nothing, using drugs, isolating, and
being out in the streets wandering around and getting into trouble. Services such as therapy
and case management do benefit clients, but are simply not enough when the world outside to
them seems chaotic and non-supportive.
The Drop In Center, beyond the once a week therapy session or case management contact, is
an obvious way to increase clients' experience and interaction with peers and staff. Such
experiences will allow the needed opportunities for clients to thrive from necessary structure,
increase normalization, develop natural supports, and feel more comfortable engaging in more
formal or traditional treatment options. Clients will improve as a result of therapy and case
management support and the Drop In Center will provide a venue to practice their new learning
and skills in an in-vivo setting. This type of service delivery system will wrap around them
providing formal and informal supports, structure, and a venue to practice skills increasing their
chances for successes in recovery and in becoming independent adults.
Unity/Encouragement:
A Drop In Center can be staffed and designed to model unity and support individuals in coming
together to encourage one another. Often, during less formal operations within the program,
clients have spontaneously verbalized that they witnessed staff encouraging one another and
working together in unity. This experience of adults working together peacefully and with joy
has been identified by clients as a new experience for them. Specifically, they report that such
unity is not what they have seen in their families, amongst friends, or in their communities.
Clients are identifying that new and more functional experiences are necessary for them to
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learn and grow in becoming a productive members of society. The Drop In Center allows staff
to create and participate in an environment that would provide more opportunities for clients to
learn about unity amongst peers, family members, and staff and be encouraged by those
individuals in a variety of programming available throughout the day. Staff, volunteers, and
mentors in the TAY program and in the Drop In Center both inside and outside the program
would be designated to provide interactive groups, activities, and learning opportunities through
one-on-one and group formats.
Materials Needed to Meet the Needs of Clients at the Drop In Center and Program
Expenses:
The Drop In Center will be located in an existing County-owned building and space. However,
equipment such as tables and chairs as well as appropriate furnishings will be needed. Other
operational expenses include office supplies and networking information technology support.
Educational supplies such as journals and self-help books will be provided to the clients as part
of their therapeutic activities. Texts will be purchased to populate a reference library on FEP
and will be used by both clients and program staff. Transportation assistance in the form of bus
passes along with contracted transportation services will enable clients to travel to the Drop In
Center as well as off-site activities when it is determined that without such assistance, clients
would have no or limited access. Medication support expenses will be provided to clients who
are not compliant with their treatment due to no insurance coverage. In addition, the following
specialty items are requested to be funded:
Computers, Tablets, Printer, Flat Screen TV, Projector and Cables -These items will be used
to support clients in developing school and job readiness skills, assist them in completing
applications for higher education and jobs, and enable access to the internet as a source of
information to educate themselves regarding their disorders and a means to reduce stigma.
Program Supplies-Drop In Center groups and activities led by program staff and provided to
FEP clients include themes such as family and social supports, employment and education
readiness, substance abuse awareness, and recovery and wellness. Materials needed during
the course of these groups and activities will be variable in order to meet the themes and do
whatever it takes to assist in reducing symptoms, reducing relapse rates, and preventing
deterioration of cognitive functioning. Examples include the promotion of daily living skills
through hygiene kits provided to clients as well as demonstrations of healthy and economical
snack preparation. Additional employment support may include the purchase of clothing for
clients who provide evidence of a scheduled job interview.
Art Therapy Supplies:
• Art stimulates social interaction.
• It allows one to tell their own story in ways that are more comfortable for some people.
• Allows for the discovery of new strengths and creativity. Utilizes present strengths and
develops confidence.
• Increases the ability to focus.
• Provides opportunities to receive constructive feedback.
• Supports collaboration.
• Teaches dedication.
• Art teaches clients about valuable aspects of life.
• It supports clients' understanding of perspective about their place in the world.
• Encourages clients to move beyond their comfort zone.
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Healthy, Nutritious Snacks:
• Food draws people in and will increase outreach.
• By providing snacks, a client has one less thing to worry about thereby increasing the
chances that they will participate in the program.
• Snacking with others gives a sense of community/family that clients often do not have
much experience with or the experiences they have had are negative ones.
• Having a snack reduces post meal sleepiness thereby increasing the opportunity for
clients to benefit from our services. Snacks keep and maintain energy levels. Protein
snacks increases the production of neurotransmitters that regulate concentration and
alertness. Concentration is increased with such snacks as vegetables, hummus,
popcorn, and low calorie energy bars.
• Healthy snacks can be used to support healthy eating habits, particularly for those who
struggle to eat well.
Recreational Group Therapy Trips-Trips to the bowling alley, movie theater, and other off-site
cultural or educational locations to be determined will:
• Promote socialization among peers and normalization;
• Reconnect clients around activities that are social and pleasurable;
• Increase physical fitness and mental health; and
• Effectively engage the client and retain them in their treatment by providing additional
youth-friendly and stigma-free life experiences away from the clinical setting.
Staff and Included Programs:
No staff will be funded by the FEP Set-Aside funding allocation since the Drop In Center would
include programs that are staffed by existing program staff, staff from formed alliances, and
volunteers. Staff would include Peer Support Specialists, Community Mental Health Specialist,
Recreational Therapists, Job Specialists, Student Volunteers, Academic Tutors, Substance
Abuse Specialists, and peer volunteers. A Peer Support Specialist and a Community Mental
Health Specialist would be designated as coordinators for the Drop In Center. Therapist and
Case Managers alternate schedules to run groups and facilitate activities. A collaborative
partner within the Department would be assigned from the Supportive Employment and
Education Services program to work with clients at the computer work stations.
Other collaborative partners would include Substance Abuse Specialists from the Department's
drug and alcohol program to run groups for co-occurring disorders. In addition, the Drop In
Center would be used as a means to promote job readiness that could include Peer Mentor
positions in this program that the Department would like to develop and seek future funding.
Hours of Operation & Location:
Hours of operation and staffing for the Drop In Center are to be coordinated between the hours
of 10 AM to 4 PM from Monday through Friday. There are three potential sites: the main lobby
in the existing building, one of the conference rooms in the same building, or a nearby modular
building.
Client and Family Engagement Process:
Outreach to clients and their families would begin at the time of admission and continue
throughout treatment until discharge. Part of the discharge plan would include same day access
to their outpatient mental health services only a few yards from the PHF. Parents and
caregivers would be engaged throughout the hospital stay and encouraged to immediately
attend the program's Family Group for those with FEP. Providing this level of integrated care
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would allow for another expansion of an evidenced-based practice of family group for clients
and families experiencing FEP.
Treatment Team Members:
The current staffing for the programs includes one Clinical Supervisor, four Mental Health
Clinicians, five Community Mental Health Specialists (also known as case managers), one part
-time (0.50 FTE) Psychiatrist, and one Peer Support Specialist. There are also ten vacancies
and two stipend positions to be filled for the team to be at full capacity (five clinicians, three
case managers, one Psychiatrist, one peer provider, and two peer mentors). FEP set-aside
funds will not be utilized during FY 2015-16 to fund staff positions.
Role of Clinical Supervisor:
The Clinical Supervisor has full supervisory responsibilities over clinical and support staff.
These responsibilities include interviewing, selecting, training, assigning, directing, monitoring,
and evaluating staff. The Clinical Supervisor consults with a Division Manager regarding
program goals, activities, policies; procedures, and communicates and interprets program
goals, policies, and procedures to staff, community agencies, clients, and the public. The
Clinical Supervisor assures that county, department, and program policies are properly
implemented. He/she develops and implements work schedules to assure proper program
coverage. He/she ensures staff proficiency in behavioral health information and other
information system utilized by the particular program, reviews case files to assure compliance
with departmental and state policies, procedures and billing requirements, as well as assists
management staff in the development and monitoring of program budgets.
Role of Mental Health Clinician:
The Mental Health Clinician classification series is utilized to provide professional mental health
services and individual, group, marital, and family therapy and counseling to mentally ill or
emotionally-disturbed children and adults. The Mental Health Clinician evaluates client
psychosocial dysfunction and formulates a behavioral health wellness and recovery service
plan. The Clinician conducts individual, group, marital, family therapy, case management,
rehabilitation, and counseling sessions as part of a behavioral health well ness and recovery
service plan. He/she provides crisis intervention services to clients as well as behavioral health
consultative services to professional personnel of other agencies to help them better serve their
clients and families. Clinicians speak to community lay and professional groups to promote
behavioral health, well ness and recovery and anti-stigma practices. He/she participates in staff
development programs and in staff conferences regarding clients' well ness and recovery and
professional behavioral health approaches. The Clinician counsels and consults with clients,
families, other professional staff and community agencies regarding recommendations for
wellness and recovery service planning.
Role of Communitv Mental Health Specialist:
The Community Mental Health Specialist (CMHS) is responsible for providing case
management and supportive services to adults with chronic mental illness or co-occurring
disorders and/or emotionally disturbed children and youth. Incumbents receive training, close
supervision, and direction in the performance of assignments. The CMHS interviews clients,
individually or in group settings, to determine their barriers to recovery and related needs
concerning the necessities of day-to-day living such as housing, employment, and home
budgeting. Under clinical direction, the CMHS develops and implements a treatment plan to
help the client reduce barriers to recovery and address their needs concerning the necessities
of day-today living. The CMHS also assists clients toward achievement of recovery goals
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through implementation of both individual and group interventions aimed at increasing skills and
decreasing symptoms. The CMHS documents interventions and client's progress in treatment.
Role of Peer Support Specialists:
Under immediate supervision, a Peer Support Specialist (PSS) provides information, support,
assistance, advocacy, and service effectiveness review for clients or family
members/caregivers of clients of the behavioral health system. The Peer Support Specialist
classification is responsible for monitoring, informing, supporting, assisting and empowering
clients and their family/caregivers who directly or indirectly receive behavioral health services.
The Peer Support Specialist is also responsible for developing and coordinating activities,
programs and resources which directly support clients and family/caregivers in achieving
well ness and recovery-oriented goals; facilitating peer-to-peer assistance as a part of a team
setting; conducting outreach to clients, families/caregivers and the community; and acting in a
liaison role between clients, families/caregivers and community service providers. He/she
provides peer support and self-help services to behavioral health clients or family
members/caregivers of clients as appropriate. The PSS assists clients to develop self-
advocacy, communication and empowerment skills. He/she assists clients in obtaining benefits,
(i.e., SSI, General Relief, Medi-Cal/MediCare, Section 8, and/or identification cards). Under
immediate supervision, a PSS participates in resolving client concerns as required.
Role of Psychiatrist:
The Psychiatrist responsibilities include providing complete psychiatric assessments which may
include physical assessments and examinations, psychiatric diagnosis, and treatments of both
chronic and episodic psychiatric disorders. The Psychiatrist interviews patients to obtain
complete psychiatric and medical histories and may perform limited physical examinations. The
Psychiatrist counsels patients regarding matters pertaining to their physical and mental health,
arranges for hospital admission of patients, and facilitates the referral of patients to appropriate
health facilities, agencies, and resources. He/she orders and interprets a variety of routine tests
which may include blood counts, chemistry panels, lipid panels, liver function tests, medication
levels, EKG, etc. The Psychiatrist provides direct and indirect clinical services to patients.
He/she records findings of mental and/or developmental assessments.
Role of Peer Mentor:
The Peer Mentor's primary duties include but are not limited to the following activities for
individuals in the target population; planning recreational activities, coordinating outings and
awards ceremonies, provision of ongoing after-care and support, advocacy, outreach and
training, recruitment of potential peer mentors.
Under immediate supervision, a Peer Mentor utilizes a peer-to-peer approach in working with
clients being served in the Transition Age Youth program. The role of the Peer Mentor is to
support TA Y clients in increasing their independence, to increase their self-awareness, to
encourage clients in meeting their treatment goals, identify and link to resources in the
community, to encourage and facilitate community involvement, conduct outreach, and to
participate in the program planning process.
Specifically, the role of a Peer Mentor as an advocate is to coach and model for clients to
develop their self-advocacy skills, communication skills and to empower them towards their
recovery. Peer Mentors are supported in their role as a models and advocates for clients as
evidenced by their participation in the TAY subcommittee that was developed as part of the
Quality Assurance Committee for the Department of Behavioral Health. Their presence and
input is considered just as any other member of the committee that includes Clinical
Supervisors and Clinicians.
Page 39 of41
The role of Peer Mentor allows for in-vivo work experience that equips them to support and
encourage clients towards gainful employment versus relying on disability benefits. Mentors can
further assist clients by walking them through and supporting them in our on campus Supportive
Education and Employment Services program. This role is a means to assist clients to spring
board towards furthering their education and /or to gain employment to increase the client's
independence.
C. TARGET POPULATION
The age range for the FEP disorders target population is 16-28 years of age and will consist of
individuals who are experiencing their first onset of psychosis. FEP disorders that will be
targeted include: psychotic disorder NOS, the entire spectrum of schizophrenia disorders, and
major depression with psychosis, bipolar with psychosis, along with delusional and brief
psychotic disorders.
The population's age range and spectrum of diagnosis was chosen by Fresno County in
response to community findings over the past five years. Findings in Fresno County are
supported by a growing body of research that sites psychotic disorders, not just schizophrenia,
as presenting onset and maximum impact in late adolescence and early adult life. Furthermore,
according to Vancouver/Richmond Early Psychosis Intervention, several studies have shown
that delays between onset of psychotic symptoms and commencement of appropriate treatment
can cause significant disruption at a critical developmental stage and cause significant
secondary problems. The longer the period of untreated illness, the greater the risk for
psychological and social disruption and secondary morbidity, such as major depression, for the
person and their family. Psychotic episodes often result in isolation from others and cause
difficulties in familial and social relationships. Difficulties can be seen in school and work, and
the consequences often include unemployment, substance abuse, depression, conflict with law
enforcement, and self-harm or suicide. Some studies also show that long delays in treatment
may cause the illness to become less responsive to treatment.
During FY 2013-2014, the TAY/FOT programs served a total of 300 unique clients who
received a diagnosis of one of the identified psychotic disorders. The FY 2013-2014 program
caseloads contained 156 clients who meet the FEP criteria. Due to new outcome reporting
requirements, FEP specific information is not available at this time. During the time period from
January 1, 2014 to June 30, 2015, TAY/FOT programs served a total of 638 unique clients.
The current caseload of each program is 441 and 140 respectively.
The program enhancements, in addition to continued training and education of the treatment
team members on the evidence-based models as previously mentioned, will be focused on
formalizing partnerships with the new youth crisis stabilization center, psychiatric health
facilities and other referring providers (local hospitals, emergency departments (ED), contracted
providers) that may serve as triage opportunities. This effort would result in a larger number of
clients being served by way of early detection through education and co-location of services
and resources at an estimated rate of 30-35 adult and 10-20 children in the identified target
population.
An accurate projection of the number of clients that can be served resulting from this
collaboration requires an efficient and reliable inpatient hospitalization notification/reporting
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system which is in the process of being developed with the local hospitals and EDs and
incorporated into the Department's electronic health records system (Avatar). Furthermore, the
program augmentations are heavily geared towards improving client outcomes through better
quality of care in addition to strengthening relationships with referring organizations to bypass
system barriers to accessing appropriate services in a timely manner for individuals in the target
population.
D. STAFF ROSTER
Fresno County is not requesting new positions to be funded through the FEP Set-Aside
allocation at this time due to the uncertainty of available FEP funding on a continuing basis and
the sustainability of hiring new staff by the Department. The Drop In Center will be staffed by
existing program staff, staff from formed alliances, and volunteers.
E. DESIGNATED PEER REVIEW REPRESENTATIVE
The designated peer review representative for this project is the Director, Fresno County
Department of Public Health.
F. IMPLEMENTATION PLAN:
Currently the Fresno County Department of Behavioral Health utilizes Cognitive Behavioral
Therapy for Psychosis (CBTp) and Transition to Independence Process (TIP) Model to serve
individuals who are experiencing a first episode of psychosis. Formal training for both models
is expected to occur before the end of 2015.
Specific goals for implementation of the CBTp model will target the reduction of distress
associated with positive symptoms, functional impairments associated with negative symptoms
and wellness planning for relapse reduction with the overall aim of increasing functioning for
these individuals.
The TIP model utilizes an individualized process, engaging youth and young adults in a process
of futures planning concurrent with the provision of supports and services that are accessible,
coordinated, appealing, non-stigmatizing, trauma-informed, and developmentally-appropriate,
and that build on their own strengths. The TIP model involves youth and young adults, their
families, and other informal key players in a process that facilitates the youths' movement
towards enhanced self-sufficiency and successful achievement of personal goals. Young
people are encouraged by case managers and therapists to explore their interests and to
envision a future that relates to conventional transition domains of employment and career,
education, living situation, personal effectiveness/wellbeing, and community-life functioning.
The Drop In Center is expected to be operational once equipment and specialty items have
been approved and purchased with FEP Set-Aside funds.
G. PROGRAM EVALUATION PLAN
Individuals are transitioned out of the Coordinated Specialty Care (CSC) program upon
completion of their goals. It is determined that clients have met their goals as evidenced by the
following: (1) meeting and sustaining their treatment plan goals, (2) success as measured by
outcome instruments, and (3) client and multidisciplinary input. Transition out of the CSC
Page 41 of41
program can appear different for each client dependent upon such factors as Stage of Change,
level of functioning, recovery needs, and necessary resources.
The target goal for completion of the program is 1-2 years. Transition would include a
multidisciplinary case staffing including the client and caregiver, if appropriate. The client's
existing Futures Plan would be reviewed as a means for staff and client to evaluate the next
logical step to support the client in his or her ongoing recovery. This transition plan could
include a step-down to a lower level of care such as the Department's Metro Outpatient division
or to a contracted private provider in the community. Transitions may or may not include
ongoing clinical services depending on the client's needs, successful independence, and well-
being. For instance, some clients who have successfully achieved a high degree of recovery
may be stable and thriving as evidenced by independent living, employment, involvement with
community resources, volunteering, or completing their education as a step towards initial or a
step up in their careers. In the instance that a client is not achieving their goals in the esc
program then a multidisciplinary case staffing would occur, including the client and caregiver, if
appropriate to determine a higher level of care such as a Full Service Partnership TAY
program, inpatient co-occurring treatment, or consideration for conservatorship.
The enhanced program will be able to interface with the child-adolescent crisis stabilization
center and Youth PHF preventing hospitalization and when appropriate, providing immediate
same day access to outpatient follow-up care, and providing seamless step-down from
hospitalization. Additional new referral relationships will be established by partnering with the
National Association for the Mentally Ill, local state and community colleges, local hospitals and
law enforcement.
Drop In Center data will be collected to assess the number of clients served and type of
activities being utilized. Clients will be periodically surveyed to identify if the groups and
activities meet their needs and to assess their satisfaction that the services provided
contributed to their well ness and recovery.
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SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMSHA)
COUNTY COMMUNITY MENTAL HEALTH BLOCK GRANT (MHBG) RENEWAL
APPLICATION FY 2015-16
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Date: ~ /3 ~OJS
BERNICE E. SEIDEL, Clerk
Board of Supervisors
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
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COUNTY OF FRESNO
Fresno, CA
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APPROVED AS TO LEGAL FORM:
DANIEL C. CEDERBORG, COUNTY COUNSEL
By 0~
APPROVED AS TO ACCOUNTING FORM:
VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
TREASURER-TAX COLLECTOR
_A:cL-(\· -
By ________ ~~~~~---------
REVIEWED AND RECOMMENDED FOR
APPROVAL:
By-----'~:::....:__~'----"~'-=---'-------
Dawan Utecht
Director, Department of Behavioral Health
By LDtt~
David Pomaville
Director, Department of Public Health
Fund/Subclass: 000 Ill 0000
Organization: 5630 ($430,518); 5620 ($1,469,710)
Account/Program: 4380
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Date: _'1-'-i/'-=2-:....o.f+-/.l.!:IJ!.._-__
Date:
Date: _...Lq.±.:/a:.::.t.!..!/1-'='5<----_
COUNTY OF FRESNO
Fresno, CA