Title
Support request to:
a. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 023-4000-8410-HEA012 to delete 1.0 FTE vacant Contract Physician and add 1.0 FTE Behavioral Health Service Manager II; and
b. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 023-4000-8410-HEA012 to delete 2.0 FTE vacant Patient Service Representative and add 2.0 FTE Medical Assistant; and
c. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 023-4000-8410-HEA012 to delete 1.0 FTE vacant Public Health Nurse II and add 1.0 FTE Public Health LVN; and
d. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 023-4000-8410-HEA012 to delete 2.5 FTE vacant Psychiatric Social Worker II and add 3.0 FTE Sr. Psychiatric Social Worker; and
e. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 023-4000-8410-HEA012 to delete 0.125, 0.200, 0.250, 0.250, 0.200 (1.025) FTE vacant Behavioral Health Aide and add 1.0 FTE Behavioral Health Aide; and
f. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 023-4000-8410-HEA012 to add 0.20 FTE Psychiatric Social Worker II; and
g. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 023-4000-8410-HEA012 to add 0.60 FTE Social Worker III; and
h. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to add 18.0 FTE Psychiatric Social Worker II, 3.0 FTE Social Worker III, 3.0 Behavioral Health Unit Supervisor, 1.0 FTE Office Assistant III, 1.0 FTE Management Analyst II; and
i. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to add 1.0 FTE Secretary; and
j. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to add 1.0 FTE Office Assistant II, 1.0 FTE Medical Records Technician, 1.0 FTE Management Analyst II; and
k. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to add 1.0 FTE Psychiatric Social Worker II, 1.0 FTE Sr. Psychiatric Social Worker; and
l. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to add 1.0 FTE Assistant Bureau Chief; and
m. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to increase revenue and appropriations by $1,675,194to accommodate revenue and expenditure increases resulting from the approval of all action items recommended in this report.
Report
RECOMMENDATION:
It is recommended that the Budget Committee of the Board of Supervisors Support Request to:
a. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to delete 1.0 FTE vacant Contract Physician and add 1.0 FTE Behavioral Health Service Manager II; and
b. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to delete 2.0 FTE vacant Patient Service Representative and add 2.0 FTE Medical Assistant; and
c. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to delete 1.0 FTE vacant Public Health Nurse II and add 1.0 FTE Public Health LVN; and
d. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to delete 2.5 FTE vacant Psychiatric Social Worker II and add 3.0 FTE Sr. Psychiatric Social Worker; and
e. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to delete 0.125, 0.200, 0.250, 0.250, 0.200 (1.025) FTE vacant Behavioral Health Aide and add 1.0 FTE Behavioral Health Aide; and
f. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to add 0.20 FTE Psychiatric Social Worker II; and
g. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to add 0.60 FTE Social Worker III; and
h. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to add 18.0 FTE Psychiatric Social Worker II, 3.0 FTE Social Worker III, 3.0 Behavioral Health Unit Supervisor, 1.0 FTE Office Assistant III, 1.0 FTE Management Analyst II; and
i. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to add 1.0 FTE Secretary; and
j. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to add 1.0 FTE Office Assistant II, 1.0 FTE Medical Records Technician, 1.0 FTE Management Analyst II; and
k. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to add 1.0 FTE Psychiatric Social Worker II, 1.0 FTE Sr. Psychiatric Social Worker; and
l. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to add 1.0 FTE Assistant Bureau Chief; and
m. Amend the Fiscal Year (FY) 2018-19 Health Department Budget 4000-8410-HEA012 to increase revenue and appropriations by $1,675,194, to accommodate revenue and expenditure increases resulting from the approval of all action items recommended in this report.
SUMMARY/DISCUSSION:
The Health Department Behavioral Health Bureau (HDBHB) seeks the Budget Committee’s support to amend the FY 2018-19 adopted positions within the Behavioral Health Bureau, Unit 8410. The recommended changes are intended to provide the Bureau the type and level of staffing required to optimize service delivery across programs. The proposed changes are as follows:
The majority of items “a” through “g” represent reallocation of positions which will enable the HDBHB better align its response to changes in demand for services. The change in demand required a different staffing structure for which programs lacked the FTE allocations in the classifications needed. As a result, positions were under-filled to meet programs’ immediate needs. If approved this action will align the type and level of resources needed to meet programs’ needs. The net positions added total 1.275 FTE.
Item “h” is requested in response to increased demand for services from education partners. Co-located behavioral health clinicians address emerging issues in the student population by providing services at school sites across the county. This approach aims to address students’ issues at the earliest stage to prevent or limit their progression. The request is inclusive of the clinical and the administrative positions needed to expand the program. The positions associated with this request total 26.0 FTE. On October 18, 2018, Behavioral Health staff provided a report to the Health, Housing, and Human Services Committee on the implementation of school-based mental health services and need for expansion. The Committee voiced support for the expansion of services, and for the proposal to submit a request for the Board’s consideration to expand the workforce.
Item “i” requests to add a secretary position, 1.0 FTE, whose main function will be to provide administrative support to the Medical Director, including scheduling appointments, maintaining calendars, draft correspondence and meeting agendas, etc.
Item “j” requests to add administrative support for Quality Assurance. The addition of these positions, 3.0 FTEs, will allow for the transfer of clerical and administrative duties to support staff and allow licensed clinical staff to focus on quality assurance activities to ensure the Bureau remains in compliance with State and Federal Regulations.
Item “k” requests additional staffing to enhance the Mobile Crisis Team. The Mobile Crisis Team provides support to law enforcement and other community partners throughout the county, and through brief crisis interventions the team can divert clients who do not need hospitalization away from the emergency room and link them to available resources and supports in the community. As it is currently staffed, the team provides services Wednesday through Saturday and alternating Tuesdays. The additional staff, 2.0 FTEs, will allow expansion of mobile crisis service delivery to seven days a week.
Item “l” requests the addition of an assistant Bureau Chief, 1.0 FTE. The Assistant Bureau Chief will support the Bureau Chief in the administration of Bureau’s Resources. With the implementation of the Affordable Care Act, the Bureau’s budget has grown to over $110 M annually, and 426.25 FTEs. Along with the Bureau Chief, the Assistant Bureau Chief will provide leadership and direction to staff to help achieve the Bureau’s strategic goals. The Assistant Bureau Chief will work with community-based organizations, partners within and outside of the County, and the public to ensure that programs and services address the needs for the target population. In addition, this position will ensure compliance with State and Federal regulatory requirements and will help the Bureau prepare for a potential transition from a fee for service to a capitation model, which requires a thorough understanding of risk-based payments and their potential impacts.
Item “m” requests to increase revenue and appropriations to the level estimated to be realized in FY 2018-19 if all the recommended actions in this report are approved.
These reallocations support the Monterey County Health Department 2018-2022 Strategic Plan Initiatives: 3) Ensure access to culturally and linguistically appropriate, customer-friendly, quality health services; and 4) Engage Monterey County Health Department workforce and improve operational functions to meet current and developing population health needs.
OTHER AGENCY INVOLVEMENT:
The County Administrative Office Budget Office, Auditor-Controller, County Counsel and Human Resources have reviewed the recommendations.
FINANCING:
The grand total new FTE allocations requested are 34.275, and the additional costs are estimated at $1,675,194 for FY 2018-19, and $4,382,522 in FY 2019-20. The new positions will be funded with Federal Financial Participation (FFP) 24%, Sales Tax Realignment 8%, Mental Health Services Act 7%, and reimbursements from school districts 61%.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
Check the related Board of Supervisors Strategic Initiatives:
☐Economic Development:
• Through collaboration, strengthen economic development to ensure a diversified and healthy economy.
☒Administration:
• Promote an organization that practices efficient and effective resource management and is recognized for responsiveness, strong customer orientation, accountability and transparency.
☒Health & Human Services:
• Improve health and quality of life through County supported policies, programs, and services; promoting access to equitable opportunities for healthy choices and healthy environments in collaboration with communities.
☐Infrastructure:
• Plan and develop a sustainable, physical infrastructure that improves the quality of life for County residents and supports economic development results.
☐Public Safety:
• Create a safe environment for people to achieve their potential, leading businesses and communities to thrive and grow by reducing violent crimes as well as crimes in general.
Prepared by: Miriam Y. Mendoza-Hernández, Finance Manager, Ext. 4578
Approved by: Elsa M. Jimenez, Director of Health, Ext. 4526
Attachments:
Attachment A - Funding Table
Attachment B - FTE and Reallocations