Title
Approve and authorize the Director of Health or Assistant Director of Health to execute Amendment No. 2 to Mental Health Services Agreement A-15302 between Monterey County Health Department, Behavioral Health Bureau (MCBHB) and Interim, Inc. which adds five new programs in Fiscal Year (FY) 2022-23 (Peer Partners for Health Primary Care Integration, Keep it Real Community Outreach and Navigation, Success Over Stigma post-COVID restart, Transportation Coaching, and Academy Day Rehabilitation Program), expands two existing programs (Wellness Navigation Program, and Choices Day Treatment Intensive Program), revises FY 2022-23 rates to reflect increased staff and operational costs that increases FY 2022-23 funding amount by $5,202,581 for a new total Agreement amount not to exceed $38,150,450 for the full-term July 1, 2021 - June 30, 2023.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
Approve and authorize the Director of Health or Assistant Director of Health to execute Amendment No. 2 to Mental Health Services Agreement A-15302 between Monterey County Health Department, Behavioral Health Bureau (MCBHB) and Interim, Inc. which adds five new programs in Fiscal Year (FY) 2022-23 (Peer Partners for Health Primary Care Integration, Keep it Real Community Outreach and Navigation, Success Over Stigma post-COVID restart, Transportation Coaching, and Academy Day Rehabilitation Program), expands two existing programs (Wellness Navigation Program, and Choices Day Treatment Intensive Program), revises FY 2022-23 rates to reflect increased staff and operational costs that increases FY 2022-23 funding amount by $5,202,581 for a new total Agreement amount not to exceed $38,150,450 for the full-term July 1, 2021 - June 30, 2023.
SUMMARY/DISCUSSION:
The County currently has Agreement A-15302 with Interim, Inc. for a current contracted dollar amount of $32,947,869. This Amendment No. 2 adds $5,202,581 for FY 2022-23 for a new contract amount of $38,150,450. For over four decades, Interim, Inc. has provided residential and day treatment programs, supportive housing, homeless outreach, dual recovery, peer wellness navigation and community-based wellness and recovery activities that provide normalizing experiences for adults with serious mental illnesses, many of who also have co- occurring substance abuse disorders. The Health Department, Behavioral Health Bureau is requesting approval of this Amendment No. 2 to Agreement A-15302 to provide five (5) additional programs in FY 2022-23:
• Peer Partners for Health Primary Care Integration provides Wellness Navigators who offer an array of peer counseling and support services to enrolled consumers focused on increasing accessibility to primary healthcare services.
• Keep it Real Community Outreach and Navigation provides outreach to residents to the Monterey County community at large to facilitate advocacy and access to services. Focus population is Transition Aged Youth (TAY) and other adults who have mental health and/or substance use problems that they or others have identified interfere with their lives, such as creating barriers to employment, education, activities of daily living, and other meaningful activities, social and family relationships.
• Success Over Stigma post-COVID restart and expanded program promotes consumer involvement in advocating for public policies that support and empower people with psychiatric disabilities. Focus population is adults with mental health challenges.
• Transportation Coaching by Wellness Navigators supports client mobility and independence by taking public transportation bus with clients, educating clients on how public transit system works, and helping reduce fears associated with using this public system.
• Academy Day Rehabilitation Program uses wellness and recovery principles to develop the coping and recovery skills needed to successfully reintegrate into the community. The program provides evaluation, rehabilitation, and mental health services to maintain or restore personal independence and functioning consistent with requirements for learning and development.
The Health Department, Behavioral Health Bureau also requests approval of Amendment No. 2 to provide Interim, Inc. increases in wages and operating costs. Wage increases are necessary due to difficulty in hiring and retaining staff. Interim, Inc. wages are significantly lower for comparable positions than those offered by the County and other local providers. For example, Interim, Inc.’s BA level Counselor positions are paid 25-28% less than the comparable MCBH Social Worker III positions. This position comprises a substantial number of Interim, Inc.’s staffing for residential treatment programs and case managers. The wage issues, along with the COVID-19 pandemic, have led to Interim, Inc. turnover rates of 30-35% in this position alone. Interim, Inc.’s Behavioral Health Clinicians are paid 10- 15% less than the comparable MCBH Psychiatric Social Worker I and II, which has led to turnover rates of 50-60%. Staff most often indicate “better opportunity” as the reason for leaving. Additionally, the county system provides a substantially greater benefit package, including health insurance for dependents, the PERS retirement system, and the number of days for vacation, sick leave, and holidays.
Interim, Inc. costs have also increased for telepsychiatry as these are independent contractors; Interim, Inc. must contract this service with a vendor due to the difficulty in hiring and retaining staff for this purpose. Operating costs have also increased for telephone/internet costs (41% based on actual expenses annualized plus an additional 5%), utilities (8%), household supplies (8%), vehicle maintenance (8%), food (10%), transportation (17%), and rent (6%). Lastly, Interim, Inc. has added a budget for continued COVID Personal Protective Equipment and cleaning supplies.
This work supports the Monterey County Health Department 2018-2022 Strategic Plan Goal: 3. Ensure access to culturally and linguistically appropriate, customer-friendly, quality health services. It also supports one of the ten essential public health services, specifically: 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
OTHER AGENCY INVOLVEMENT:
The Office of the County Counsel-Risk Management and Auditor-Controller have reviewed and approved this Agreement as to legal form and fiscal provisions, respectively.
FINANCING:
This agreement is funded by MHSA (57%), Federal Financial Participation (38%), Mental Health Realignment (3%) and federal grants (2%). The funding increase of $5,202,581 in FY 2022-23
is included in the Health Department's Behavioral Health (HEA012, Unit 8410) FY 2022-23 Requested Budget.
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: Patricia Zerounian, Management Analyst III, 755-4500
Approved by:
_______________________________Date:______________
Elsa Mendoza Jimenez, Director of Health, 755-4526
Attachments:
Amendment No 2
Amendment No 1
Agreement