Title
a. Receive an oral report on the Administrative Review of the Behavioral Health Adult System of Care, and support implementation of the recommendations; and
b. Amend Fiscal Year (FY) 2014-15 Health Department Budget 4000, HEA012-8410 to add 25.0 FTE Psychiatric Social Worker IIs, 1.0 FTE Social Worker III, 1.0 FTE Clinical Psychologist, 1.0 FTE Behavioral Health Unit Supervisor, 2.0 FTE Contract Physicians, and 1.0 FTE Deputy Director Behavioral Health; and
c. Amend Fiscal Year (FY) 20145-15 Health Department Budget 4000, HEA012-8410 to increase Revenue and Appropriations in the amount of $750,000; and
d. Authorize the County Administrative Office and the Auditor Controller to incorporate the position and budget changes in the FY 2014-15 Adopted Budget.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Receive an oral report on the Administrative Review of the Behavioral Health Adult System of Care, and support implementation of the recommendations; and
b. Amend Fiscal Year (FY) 2014-15 Health Department Budget 4000, HEA012-8410 to add 25.0 FTE Psychiatric Social Worker IIs, 1.0 FTE Social Worker III, 1.0 FTE Clinical Psychologist, 1.0 FTE Behavioral Health Unit Supervisor, 2.0 FTE Contract Physicians, and 1.0 FTE Deputy Director Behavioral Health; and
c. Amend Fiscal Year (FY) 20145-15 Health Department Budget 4000, HEA012-8410 to increase Revenue and Appropriations in the amount of $750,000; and
d. Authorize the County Administrative Office and the Auditor Controller to incorporate the position and budget changes in the FY 2014-15 Adopted Budget.
SUMMARY/DISCUSSION:
Last October, the Board was briefed on the administrative review process that would be undertaken in Behavioral Health. The consultants retained for this engagement completed their review of the Adult System of Care and have issued a draft report highlighting the strengths and weaknesses of the current structure, and providing recommendations including for improvement.
During the review process, access to care (ACCESS) surfaced as one of the areas in need of quick attention. The review found that the staffing level in this area is inadequate to appropriately manage the increased demand and increased level of acuity in the client population. Although this review and report focused on the Adult System of Care, the consultants noted similar issues relating to ACCESS in the Children's System of Care.
Since ACCESS is a main point of entry to treatment, the Department feels it is appropriate to begin addressing this significant finding immediately by both, making modifications to existing processes, and increasing staff capacity by adding these key positions (12.0 FTEs) as described below.
The Deputy Director Behavioral Health (1.0 FTE) will be responsible for the overall operations of Access to Treatment and Substance Use Disorder services. This position will maintain a strong collaborative relationship with partner agencies, community based organizations, and State Agencies.
The Contract Physicians (2.0 FTE) will provide diagnoses and medication management. These added positions are essential to address the increased demand in Access and the adult, children's, and managed systems of care.
The Psychiatric Social Worker IIs (2.0 FTEs) will provide additional support to the ACCESS team in order to meet the increasing number of mental health referrals. The Clinical Psychologist (1.0 FTE) will also be assigned to the ACCESS team to provide assessment for complex cases and conduct formal psychological testing.
The Psychiatric Social Worker IIs (5.0 FTEs) will provide services throughout the County to serve the general Adult System of Care population. They will conduct comprehensive assessments and treatment to those adults with serious and persistent mental illness. The Social Worker III (1.0 FTE) will provide assistance to the Psychiatric Social Workers with the goal of addressing the needs of those consumers with significant mental health needs.
In addition to the increase in staffing requested as a result of the administrative review, the Department requests additional staff (19.0 FTEs) to address an increased demand from education partners for the provision of mental health services at Monterey County Schools. County staff in these positions will provide behavioral health treatment services as a component to the written education plan, or Individualized Education Program (IEP) mandated for students receiving special education services, pursuant to the County's existing Memorandum of Understanding and Interagency Agreement with the Special Education Local Plan Area (SELPA, MOU, IA).
County staff in the 19.0 FTE positions also will provide behavioral health treatment services on-site at various school locations in Monterey County, pursuant to separate memoranda of understanding that will utilize an MOU template simultaneously being presented to the Board of Supervisors on for approval. This standard MOU template provides the terms and conditions by which County personnel shall provide non-IEP related behavioral health treatment services to all students (general education or special students) referred by school personnel. The action item on the MOU template includes a request for delegated authority to the Director of Health for execution with interested school districts. The positions requested for education partners are as described below.
The Psychiatric Social Worker IIs (18.0 FTEs) will be based in schools throughout the County providing intensive behavioral health treatment to students identified as individuals with exceptional needs. In addition, services will be delivered to general education students in an effort to prevent the need for more intensive treatment. The Behavioral Health Unit Supervisor (1.0 FTE) will be overseeing the expanded school based efforts.
These added positions will enable the Bureau to provide the highest level of quality services to the community as the demand for mental health services continues to increase.
This work supports the Monterey County Health Department 2011-2015 strategic plan initiative to ensure access to culturally and linguistically appropriate, customer-friendly, quality health services. It also supports one of the ten essential public health services, specifically assure competent public and personal health care workforce.
OTHER AGENCY INVOLVEMENT:
Human Resources Department has reviewed and agrees with the recommendations. Due to late submission of this Board Report, the CAO Budget and Analysis Division was not provided adequate time to fully review for potential fiscal, organizational, policy, or other implications to the County of Monterey .
FINANCING:
The costs of the 12 positions requested to increase department capacity are estimated at $515,263 for FY 2015. The costs of these positions, irrespective of program allocation, will be funded with $234,089 Federal Financial Participation (FFP), and $281,174 from budgeted 1991 Sales Tax Realignment. In FY 2016 these positions will be included in the Bureau's operational structure and will be funded with the same revenue streams, FFP and realignment.
The costs of the 19 positions requested for the Education Program are estimated at $615,591 for FY 2015. Said costs will be financed as follows: $385,008 will come from reimbursements from the SELPA and participating school districts; $130,903 from FFP, and $99,680 from budgeted 2011 Sales Tax Realignment. In FY 2016, the annualized costs of the positions will be incorporated in the MOUs with the SELPA and school districts.
The requested increase in revenue and appropriations in the amount of $750,000 in FY 2014-15 is for the estimated increased reimbursements from the SELPA and school districts, and increased FFP receipts. This budget modification will provide the appropriate budget capacity to accommodate this action in the FY 2014-15 Budget for Behavioral Health (Fund 023-4000-HEA012).
Prepared by: Pat Bass, Management Analyst, 4538
Approved by: Ray Bullick, Director of Health, 4526
Attachment:
Attachment A Proposed Position Counts on file with the Clerk of the Board